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Continence Care
CONTINENCE CARE
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Hollister Incorporated
Table of Contents
•
Continence Care
Medicare Utilization Chart..................................................page 64-65
Intermittent Catheters.................................................................66-68
Apogee Intermittent Catheter.......................................................66
Apogee Closed System Intermittent Catheter ...............................66
Apogee Closed System Intermittent Catheter Kit...........................67
Advance Plus Intermittent Catheter.............................................67
Advance Plus Intermittent Catheter Kit........................................68
Advance Hydro Soft Hydrophilic Catheter ...................................68
Male External Catheters ..........................................................page 69
InView Male External Catheter.....................................................69
Extended Wear Male External Catheter.........................................69
Leg Bag Systems.............................................................pages 70-71
Urinary Leg Bag ..........................................................................70
Latex-Free Urinary Leg Bag Systems & Packs...............................70
Vented Latex-Free Urinary Leg Bag Systems & Packs ...................71
Urinary Leg Bag Packs ................................................................71
Accessories......................................................................pages 71-72
Fabric Straps...............................................................................71
Latex-Free and Latex Tubing........................................................72
Collection Systems..................................................................page 72
Bedside Drainage Collection System with Anti-Reflux Valve ...........72
Retracted Penis Pouch.................................................................72
Female Urinary Pouch..................................................................72
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Hollister Incorporated
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Medicare Utilization
A4217 Sterile water/saline, 500 mL
.
A4310 Insert tray without drainage bag and without
1 tray/insertion
catheter (accessories only)
A4311 Insertion tray without drainage bag with indwelling
1 ea/mo
catheter, foley type, two-way latex with coating (teflon,
silicone, silicone elastomer or hydrophilic, etc.)
A4312 Insertion tray without drainage bag with indwelling
1 ea/mo
catheter, foley type, two-way all silicone
A4313 Insertion tray without drainage bag with indwelling
1 ea/mo
catheter, foley type, three-way, for continuous irrigation
A4314 Insertion tray with drainage bag with indwelling
1 ea/mo
catheter, foley type, two-way latex with coating (teflon,
silicone, silicone elastomer or hydrophilic, etc.)
A4315 Insertion tray with drainage bag with indwelling
1 ea/mo
catheter, foley type, two-way all silicone
A4316 Insertion tray with drainage bag with indwelling
1 ea/mo
catheter, foley type, three-way, for continuous irrigation
A4320 Irrigation tray with bulb or piston syringe, any purpose
.
A4321 Therapeutic agent for urinary catheter irrigation
.
A4322 Irrigation syringe, bulb or piston, each
.
A4326 Male external catheter with integral
.
collection chamber, any type, each
A4327 Female external urinary collection device; metal cup, each
1 ea/wk
A4328 Female external urinary collection device; pouch, each
1 ea/day
A4331 Extension drainage tubing, any type, any length, with
.
connector/adapter, for use with urinary leg bag or
urostomy pouch, each
A4332 Lubricant, individual sterile packet, each
.
A4333 Urinary catheter anchor device, adhesive skin
3 ea/wk
attachment, each
A4334 Urinary catheter anchoring device, leg strap, each
1 ea/mo
A4335 Incontinence supply; miscellaneous
.
A4338 Indwelling catheter; foley type, two-way latex with coating
1 ea/mo
(teflon, silicone, silicone elastomer, or hydrophilic, etc.), each
A4340 Indwelling catheter specialty type, (EG: coudé, mushroom,
1 ea/mo
wing, etc.), each
A4344 Indwelling catheter, foley type, two-way, all silicone, each
1 ea/mo
A4346 Indwelling catheter; foley type, three-way for continuous
1 ea/mo
irrigation, each
Medicare’s Usual Maximum Quantity for Urological Supplies
The quantity of urological supplies needed by a patient is determined by
many factors. There will be variation according to individual need and their
needs may vary over time. The table below lists the maximum number of
items/units of service that are usually medically necessary. The actual
quantity needed for a particular patient may be more or less than the
amount listed. The medical necessity for use of a greater quantity of
supplies than the amounts listed must be clearly documented in the
patient's medical record.
Per LCD for Urological Supplies (L5080), TriCenturion, Effective January 1, 2006
Incorporated code changes per Medicare DME PSC Bulletin Bul20061201HCPCS2007
HCPCS Long Description
Quantity
*
No established usual maximum, refer to Medicare Utilization Guidelines.
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A4349 Male external catheter, with or without adhesive,
35 ea/mo
disposable, each
A4351 Intermittent urinary catheter; straight tip, with or without
1/wk
coating (teflon, silicone, silicone elastomer, or hydrophilic,
etc.), each
A4352 Intermittent urinary catheter; coudé (curved) tip, with or
1/wk
without coating (teflon, silicone, silicone elastomeric, or
hydrophilic, etc.), each
A4353 Intermittent urinary catheter, with insertion supplies
1 ea/insertion
A4354 Insertion tray with drainage bag but without catheter
1 ea/mo
A4355 Irrigation tubing set for continuous bladder irrigation
.
through a three-way indwelling foley catheter, each
A4356 External urethral clamp or compression device
1 ea/3 mo
(not to be used for catheter clamp), each
A4357 Bedside drainage bag, day or night, with or without
2 ea/mo
anti-reflux device, with our without tube, each
A4358 Urinary drainage bag, leg or abdomen, vinyl, with or
2 ea/mo
without tube, with straps, each
A4365 Adhesive remover wipes, any type, per 50
.
A4402 Lubricant, per ounce
8 oz/mo
A4450 Tape, non-waterproof, per 18 square inches
10 units (18sq in)/ mo
A4452 Tape, waterproof, per 18 square inches
10 units (18sq in)/ mo
A4455 Adhesive remover or solvent (for tape, cement or other adhesive),
per ounce
.
A4520 Incontinence garment, any type, (E.G. brief, diaper), each
.
A4554 Disposable underpads, all sizes
.
A5102 Bedside drain bottle with or without tubing, rigid or
1 ea/3 mo
expandable, each
A5105 Urinary suspensory; with or without leg bag,with or without tube, each
.
A5112 Urinary leg bag; latex
1 ea/mo
A5113 Leg strap; latex, replacement only, per set
.
A5114 Leg strap, ‘Foam or fabric, replacement only, per set
.
A5131 Appliance cleaner, incontinence and ostomy
1 (16 oz)/mo
appliances, per 16 oz.
A5200 Percutaneous catheter/tube anchoring device, adhesive
.
skin attachment
Note: Intermittent catheterization using sterile technique is covered when the
patient requires catheterization and the patient meets one of the following
criteria (1-5):
1) The patient resides in a nursing facility
2) The patient is immunosuppressed, for example (not-all inclusive): on
immunossuppressive drugs post-transplant, on chemotherapy, AIDS,
drug-induced state such as chronic oral corticosteriod use
3) The patient has radiologically documented vesico-urethral reflux while on a
program of intermittent catheterization
4) The patient is a spinal cord injured female with neurogenic bladder who is
pregnant (for duration of pregnancy only)
5) The patient has had distinct, recurrent urinary tract infections, while on a
program of clean intermittent catheterization, twice within the 12-month
prior to the initiation of sterile intermittent catheterization.
*
No established usual maximum, refer to Medicare Utilization Guidelines.
HCPCS Long Description
Quantity
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Intermittent Catheters
Apogee Intermittent Catheter
10xx
Case of 30
Ultra-smooth Eyelets
Case of 50
Latex-Free
Designed for Comfort
HCPCS: A4351
15" Length Stock No
Size
Description
Quantity/Case
1007
6Fr
Firm
30
16" Length Stock No
Size
Description
Quantity/Case
1018
08Fr
Firm
30
1034
10Fr
Firm
30
1048
12Fr
Firm
30
1064
14Fr
Firm
30
1082
16Fr
Firm
30
1096
18Fr
Firm
30
1046
12Fr
Soft
30
1061
14Fr
Soft
30
1049
12Fr
Curved Pkg
50
1065
14Fr
Curved Pkg
50
1074A
14Fr
Soft, Curved Pkg
50
1050
12Fr
Coudé
30
1066
14Fr
Coudé
30
1086
16Fr
Coudé
30
1087
16Fr
Coudé, Curved Pkg
50
10" Length Stock No
Size
Description
Quantity/Case
1020
08Fr
Firm
30
1040
10Fr
Firm
30
6" Length Stock No
Size
Description
Quantity/Case
1016
08Fr
Firm
30
1033
10Fr
Firm
30
1047
12Fr
Firm
30
1062
14Fr
Firm
30
1063
14Fr
Firm, No Adapter
30
Apogee Closed System Intermittent Catheter
Bxxx
Case of 100
Introducer Tip
Prelubricated
Ultra-Smooth Eyelets
1500mL Collection Bag
HCPCS: No Code
Code No
Size
Description
B6F
06Fr
Firm
B8F
08Fr
Firm
B10F
10Fr
Firm
B12F
12Fr
Firm
B14F
14Fr
Firm
B16F
16Fr
Firm
B18F
18Fr
Firm
B12C
12Fr
Coudé
B14C
14Fr
Coudé
B16C
16Fr
Coudé
B12S
12Fr
Soft
B14S
14Fr
Soft
B12R
12Fr
Red Rubber Latex
B14R
14Fr
Red Rubber Latex
B16R
16Fr
Red Rubber Latex
B14F-Female
14Fr, 6”
Firm
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Apogee Closed System Intermittent Catheter Kit
BxxxB
Case of 100
Introducer Tip
Prelubricated
Ultra-Smooth Eyelets
1500mL Collection Bag
Kit contains gloves, underpad drape,
gauze and PVP swabsticks
HCPCS: A4353
Stock No
Size
Description
B6FB
06Fr
Firm
B8FB
08Fr
Firm
B10FB
10Fr
Firm
B12FB
12Fr
Firm
B14FB
14Fr
Firm
B16FB
16Fr
Firm
B18FB
18Fr
Firm
B12CB
12Fr
Coudé
B14CB
14Fr
Coudé
B16CB
16Fr
Coudé
B12SB
12Fr
Soft
B14SB
14Fr
Soft
B12RB
12Fr
Red Rubber Latex
B14RB
14Fr
Red Rubber Latex
B16RB
16Fr
Red Rubber Latex
B14FB-Female
14Fr, 6”
Firm
Advance Plus Intermittent Catheter
940xx/941xx/951xx
Box of 100
Latex-Free
Patented Gel Reservoir
Unique Protective Tip
1500 mL Collection Bag
Ultra-Smooth Eyelets
HCPCS: No Code
Stock No
Size
Description
94064
06Fr
Straight
94084
08Fr
Straight
94104
10Fr
Straight
94124
12Fr
Straight
94144
14Fr
Straight
94164
16Fr
Straight
94184
18Fr
Straight
95124
12Fr
Coudé
95144
14Fr
Coudé
95164
16Fr
Coudé
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Intermittent Catheters
Advance Plus Intermittent Catheter Kit
960xx/961xx/971xx
Box of 100
Latex-Free
Patented Gel Reservoir
Unique Protective Tip
1500 mL Collection Bag
Ultra-Smooth Eyelets
Kit contains gloves, underpad
drape, and Benzalkonium Chloride swabsticks
HCPCS: A4353
Stock No
Size
Description
96064
06Fr
Straight
96084
08Fr
Straight
96104
10Fr
Straight
96124
12Fr
Straight
96144
14Fr
Straight
96164
16Fr
Straight
96184
18Fr
Straight
97124
12Fr
Coudé
97144
14Fr
Coudé
97164
16Fr
Coudé
Advance Hydro Soft Hydrophilic Catheter
801xx
Box of 30
Latex-Free
Low Friction Hydrophilic Coating
Ultra-Smooth Eyelets
Secure Grip Section
HCPCS: A4351
6" Length Stock No
Size
Description
80103
10Fr
Straight
80123
12Fr
Straight
80143
14Fr
Straight
80163
16Fr
Straight
10" Length Stock No
Size
Description
80085
08Fr
Straight
80105
10Fr
Straight
16" Length Stock No
Size
Description
80108
10Fr
Straight
80128
12Fr
Straight
80148
14Fr
Straight
80168
16Fr
Straight
80188
18Fr
Straight
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InView Male External Catheters
974xx/975xx/976xx
Box of 30
977xx/978xx/979xx
Box of 100
Self-Adhesive
Latex-Free
Clear Material Enables Skin Visibility
HCPCS: A4349
SPECIAL: shorter length sheath
Stock No Stock No
Box of 30 Box of 100
Color
Size
97425
97725
I
Small (25mm)
97429
97729
I
Medium (29mm)
97432
97732
I
Intermediate (32mm)
97436
97736
I
Large (36mm)
97441
97741
I
Extra Large (41mm)
STANDARD: the everyday catheter for general use
Stock No Stock No
Box of 30 Box of 100
Color
Size
97525
97825
I
Small (25mm)
97529
97829
I
Medium (29mm)
97532
97832
I
Intermediate (32mm)
97536
97836
I
Large (36mm)
97541
97841
I
Extra Large (41mm)
EXTRA: 70% more adhesive than Standard for added security
Stock No Stock No
Box of 30 Box of 100
Color
Size
97625
97925
I
Small (25mm)
97629
97929
I
Medium (29mm)
97632
97932
I
Intermediate (32mm)
97636
97936
I
Large (36mm)
97641
97941
I
Extra Large (41mm)
Extended Wear Male External Catheter
980x
Box of 12
982x
Box of 100
Self-Adhesive, Latex
Patented Inner Flap
Easy Applicator Collar
HCPCS: A4349
Stock No
Stock No
Box of 12
Box of 100
Description
9806
9826
Small - 1" (25mm)
9807
9827
Medium - 1-1/8" (29mm)
9809
9829
Intermediate - 1-1/4" (32mm)
9808
9828
Large - 1-1/2" (36mm)
Male External Catheters
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Leg Bag Systems
Latex-Free Urinary Leg Bag
9814/9805
Box of 10
Includes:
(1) Urinary Leg Bag– medium or large
HCPCS: A4335
Stock No
Description
9814
Medium - 18 oz. (540mL)
9805
Large - 30 oz. (900mL)
Latex-Free Urinary Leg Bag Combination Pack
9348/9349
Box of 12
Includes:
(1) Urinary Leg Bag – medium or large
(1) Latex-free extension tubing (18") with connector
(1) Pair fabric leg bag straps – medium (23")
HCPCS: A4358
Stock No
Description
9348
Medium - 18 oz. (540mL)
9349
Large - 30 oz. (900mL)
Latex-Free Urinary Leg Bag and Strap System
9354/9355
Box of 12
Includes:
(1) Urinary Leg Bag – medium or large
(1) Pair fabric leg bag straps – medium (23")
HCPCS: A4358
Stock No
Description
9354
Medium - 18 oz. (540mL)
9355
Large - 30 oz. (900mL)
Latex-Free Urinary Leg Bag and Tubing System
9356/9357
Box of 12
Includes:
(1) Urinary Leg Bag – medium or large
(1) Latex-Free extension tubing (18") with connector
HCPCS: A4335
Stock No
Description
9356
Medium - 18 oz. (540mL)
9357
Large - 30 oz. (900mL)
Hollister Leg Bags Offer Many Benefits:
Soft, vinyl material is comfortable
Pleats provide a discreet profile
Wide, woven fabric straps are comfortable and stay in place
Easy to operate drain valve requires minimal dexterity
Protected buttons on the bags significantly decrease the risk
of pressure points
Anti-reflux valve prevents urine back flow in the tubing
ForFecal Collection Systems,
refer to page 77 in Critical Care Products.
ForSkin Care Products,
refer to page 95 in Hollister Wound Care Products.
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Vented Latex-Free Urinary Leg Bag Combination Pack
9645/9655
Box of 10
Includes:
(1) Vented Urinary Leg Bag with sterile fluid pathway –
medium or large
(1) Latex-Free, kink-resistant extension tubing with
vacuum relief valve
(1) Pair fabric leg bag straps – medium (23")
HCPCS: A4358
Stock No
Description
9645
Medium - 18 oz. (540mL)
9655
Large - 30 oz. (900mL)
Vented Latex-Free Urinary Leg Bag System
9845/9855
Box of 10
Includes:
(1) Vented Urinary Leg Bag with sterile fluid pathway –
medium or large
(1) Latex-Free, kink-resistant extension tubing with
vacuum relief valve
HCPCS: A4335
Stock No
Description
9845
Medium - 18 oz. (540mL)
9855
Large - 30 oz. (900mL)
Urinary Leg Bag 4 Pack
9834/9835
Single Unit
Urinary Leg Bag 4 Pack contains:
(4) Urinary Leg Bags – medium or large
(1) Latex extension tubing with connector
(1) Pair fabric leg bag straps – medium (23")
HCPCS: A4358
Stock No
Description
9834
Medium - 18 oz. (540mL)
9835
Large - 30 oz. (900mL)
Urinary Leg Bag Combination Pack
9824/9825
Box of 12
Includes:
(1) Urinary Leg Bag – medium or large
(1) Latex extension tubing with connector
(1) Pair fabric leg bag straps – medium (23")
HCPCS: A4358
Stock No
Description
9824
Medium - 18 oz. (540mL)
9825
Large - 30 oz. (900mL)
Fabric Leg Bag Straps
9342/9343/9344
10 Pair
Latex-Free
HCPCS: A5114
Stock No
Description
9342
Small - 15" (38cm)
9343
Medium - 23" (58cm)
9344
Large - 30" (76cm)
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Accessories & Collection Systems
Latex-Free Extension Tubing
9345/9346
Box of 10
Latex-free, kink-resistant extension tubing
with connector.
HCPCS: A4331
Stock No
Description
9345
Non-sterile
9346
Sterile
Latex Extension Tubing
9803/9813
Box of 10
Latex extension tubing with connector.
HCPCS: A4331
Stock No
Description
9803
Non-sterile
9813
Sterile
Bedside Drainage Collection System with Anti-Reflux Valve
9839
Box of 20
Includes:
Latex-Free
Sample port
Sterile fluid pathway
HCPCS: A4357
Stock No
Description
9839
68 oz. (2000mL)
Retracted Penis Pouch External Collection Device
9873
Box of 10
Cut-to-Fit, Flextend Skin Barrier
Thinner and More Flexible
No Additional Tape Needed
Odor-Barrier Film
Convenience Drain
HCPCS: A4326
Stock No
Description
9873
Retracted Penis Pouch
9811
Box of 10
Cut-to-Fit, SoftFlex Skin Barrier
Odor-Barrier Film
Convenience Drain
Tape Strips and Skin Gel Wipe Included
HCPCS: A4326
Stock No
Description
9811
Retracted Penis Pouch
Female Urinary Pouch
9840
Box of 10
Cut-to-Fit, SoftFlex Skin Barrier
Odor-Barrier Film
Convenience Drain
Alternative to indwelling catheter for bedbound females
HCPCS: A4328
Stock No
Description
9840
Female Urinary Pouch
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