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Since these pages were converted from PDF, some of the content may appear garbled. To the best of our knowledge, the information contained herein is accurate. However, neither Binson's, or any of its subsidiaries assumes any liability whatsoever for the accuracy or completeness of the information contained herein. This manufacturer information is for educational purposes only.
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Page 1
2005
ProductsCatalog
Ostomy
Urologicals/Continence Care
Wound Care
Hollister Incorporated
2000 Hollister Drive
Libertyville, Illinois 60048
USA
Hollister and logo, Hollister, Adapt,
Advance Hydro Soft, Advance Plus,
CalciCare, CenterPointLock, ComfortWear,
Contour I, FirstChoice, Flextend, FlexWear,
HeelBoot, HolliHesive, InView, Karaya 5,
Lock ’n Roll, m9, New Image, PinCare,
Pouchkins, Premier, Restore, Secure Start
and SoftFlex are trademarks of Hollister
Incorporated, Libertyville, Illinois USA.
Shadow Buddies is a trademark of
Shadow Buddies.
Cann-U-Wrap, CubiPad, and Heelbo are
trademarks of Heelbo Incorporated.
© 2005 Hollister Incorporated.
Printed in USA.
907179-205
For more information, please call us:
TOLL FREE: 1.800.323.4060
FAX: 847.680.1017
Visit our web site:
www.hollister.com
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Page 2
3
Hollister Incorpora ted
General Informa
tion
Hollister Incorpora ted
2
General Information
HCPCS Codes Disclaimer
The reimbursement information provided by Hollister Incorporated
is intended to provide general information relevant to coding and
reimbursement of Hollister products only. Reimbursement policies can
vary considerably from one insurer to another. Coverage and payment
policies for the same insurer, such as Medicare, can vary from one
region to another, and may change from time to time. Hollister does
not guarantee coverage or payment of products listed in thiscatalog.
This information is designed as a guideline only.
HCPCS codes shown in this ProductCatalog are effective 1-1-05.
Explanation of Third Party Code Reimbursement System
To facilitate reimbursement of Hollister products, some Third Party
Payment Programs require the use of an eleven digit reimbursement
number. Every Hollister manufactured product can be identified by an
eleven digit number. The first five numbers identify the manufacturer
and the last six numbers represent the product stock number. In order
to utilize this coding system, follow these examples.
To code a four-digit stock number:
The Third Party Reimbursement Number for the Premier Drainable
Pouch, Stock Number 8531 listed in thecatalog on page 34, is:
08380-0085-31
08380 identifies Hollister Incorporated. 0085-31 identifies the product
Stock Number.
To code a five-digit stock number:
The Third Party Reimbursement Number for the InView Male External
Catheter, Stock Number 97529 listed in thecatalog on page 90, is:
08380-0975-29
08380 identifies Hollister Incorporated. 0975-29 identifies the product
Stock Number.
Latex Statement
The specifications for the Hollister Urologicals/Continence Care
products listed below do include natural rubber latex as a component;
our suppliers do add natural rubber latex as part of the production
process.
Stock Numbers:
9606
9607
9608
9609
9626
9627
9628
9629
9803
9806
9807
9808
9809
9813
9816
9817
9818
9824
9825
9826
9827
9828
9829
9834
9835
9836
9897
9898
If a Hollister product(s) found in thiscatalog is not listed above, the
specification for that product(s) and packaging does not include
natural rubber latex as a component, and our component suppliers do
not add natural rubber as part of their production process.
How to Use The Hollister ProductsCatalog
Hollister has created this simplified ProductCatalog to help our cus-
tomers find what they need in a quick and efficient manner.
If you...
know the stock number (or stock series number)
Go to the numeric index at the end of each product section to find the
page number where it appears.
If you...
know the product brand or series name
Go to the Table of Contents on pages 4 through 7 to find the page
number where it appears.
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Hollister Incorpora ted
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able of Contents
Hollister Incorpora ted
4
Adapt Accessories (continued)......................................pages 44-46
Odor Eliminators & Lubricants....................................................45
Adapt Lubricating Deodorant..................................................45
Odor Eliminator Spray............................................................45
Cleaner/Decrystallizer............................................................46
Ostomy Belt, Drainable Pouch Clamp, and Urostomy
Drain Tube Adapter................................................................46
OTHER OSTOMY PRODUCTS
Two-Piece Pouching Systems.......................................pages 48-55
CenterPointLock...................................................................48-55
One-Piece Pouching Systems.......................................pages 56-65
FirstChoice...........................................................................56-59
Contour I..............................................................................60-61
Karaya 5..............................................................................62-64
Other One-Piece Products..........................................................65
Ostomy Accessories......................................................pages 66-67
Skin Care Products....................................................................66
Irrigation Products......................................................................66
Loop Ostomy Bridge ..................................................................66
Replacement Filters ...................................................................67
Bedside Drainage Collector ........................................................67
Skin Barrier Pastes and Powders................................................67
Karaya Paste.........................................................................67
Karaya Powder......................................................................67
Skin Barriers..............................................................................67
Premium (standard wear) Skin Barrier....................................67
HolliHesive (standard wear) Skin Barrier .................................67
Odor Eliminator Drops................................................................67
Conversion Charts.........................................................pages 68-73
Two-Piece: CenterPointLock to New Image............................69-71
One-Piece: FirstChoice to Premier..............................................72
Old to New Accessories .............................................................73
Discontinued Products..................................................pages 74-77
Glossary for Ostomy Products.......................................pages 78-79
Educational Resources..................................................pages 80-81
Stock Number Index.....................................................pages 82-83
Ostomy Products pgs 9 - 83
Ostomy Table of Contents........................................................10-11
Quick Reference/Product Selection Guides...................pages 12-21
New Image Two-Piece Pouching System Skin Barriers...........12-13
New Image Two-Piece Pouching System Pouches.................14-15
New Image Two-Piece Pouching System Single Use Kits.............16
Premier One-Piece Pouching System Pouches......................18-21
Medicare Utilization Chart .......................................................22-23
New Image Two-Piece Pouching System......................pages 24-33
Skin Barriers ........................................................................24-28
Drainable Pouches ...............................................................28-30
High Output Drainable Pouches..................................................30
Closed Pouches.........................................................................31
Urostomy Pouches ...............................................................31-32
Irrigator Sleeve...........................................................................32
Non-Sterile and Sterile Kits...................................................32-33
Premier One-Piece Pouching System ...........................pages 34-41
Drainable Pouches ...............................................................34-38
Post-Operative Drainable Pouches..............................................38
Closed Pouches.........................................................................39
Urostomy Pouches ..............................................................40-41
Pouchkins Pediatric Pouching Systems.........................pages 42-43
Premie/Newborn Pouch .............................................................42
Drain Tube.................................................................................42
One-Piece Pediatric Pouches................................................42-43
Two-Piece Pediatric Pouches......................................................43
Pediatric Ostomy Belt.................................................................43
Adapt Accessories ........................................................pages 44-46
Skin Barrier Accessories.............................................................44
Adapt Barrier Rings ...............................................................44
Adapt Convex Barrier Rings ...................................................44
Adapt Barrier Strips...............................................................44
Skin Barrier Pastes and Powders................................................44
Adapt Paste ..........................................................................44
Premium Powder...................................................................44
Skin Barriers..............................................................................44
Flextend (extended wear) Skin Barrier ....................................44
Skin Gel Wipes ..........................................................................44
Skin Gel Protective Dressing Wipes........................................45
Adhesives and Removers...........................................................45
Universal Remover Wipes.......................................................45
Medical Adhesive...................................................................45
Medical Adhesive Remover....................................................45
How to Size Hollister Ostomy Pouches
A properly fitted pouch is essential to minimize stomal and skin irrita-
tion and to obtain optimum pouch wear time. A stoma measuring card
allows correct measurement of the stoma.
Measure the stoma accurately. Select the smallest barrier opening
which fits comfortably around the stoma without actually touching it.
Too large an opening will leave skin exposed and could lead to skin
irritation or erosion.
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Hollister Incorpora ted
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a
ble of Contents
Hollister Incorpora ted
6
Medicare Utilization Chart...............................................................87
Urinary Incontinence ...................................................pages 88-91
Intermittent Catheters
Hollister Intermittent Catheter...............................................88
Advance Plus Intermittent Catheter.......................................88
Advance Plus Intermittent Catheter Kit..................................89
Advance Hydro Soft Hydrophilic Catheter ..............................89
Male External Catheters
InView Male External Catheter..............................................90
Extended Wear Male External Catheter .................................90
Extended Wear Male External Catheter with Removable Tip .....91
Extended Wear Male External Catheter Starter Kits................91
Everyday Male External Catheter...........................................91
Collection Systems......................................................pages 92-95
Urinary Collection Systems
Retracted Penis Pouches......................................................92
Bedside Drainage Collection System with Anti-Reflux Valve........92
Latex-Free Urinary Leg Bags................................................92
Latex-Free Urinary Leg Bag Kits and Systems.......................93
Latex-Free Vented Urinary Leg Bag Kits and Systems............93
Latex-Free Leg Bag Accessories...........................................94
Urinary Leg Bag Kits and Systems........................................94
Leg Bag Accessories............................................................94
Female Urinary Pouch..........................................................95
Fecal Collection Devices
Fecal Collectors...................................................................95
Urologicals/Continence Care Accessories ..............................96-97
Odor Eliminators ......................................................................96
Cleaner/Decrystallizer...............................................................96
Skin Care and Skin Protectants...........................................96-97
Skin Cleanser ..........................................................................97
Educational Resources............................................................98-99
Support and Professional Groups.........................................98-99
Stock Number Index ...................................................................100
Wound Care pgs 101 - 119
Urologicals/Continence Care pgs 85 - 100
Moist Wound Dressings...........................................pages 104-105
Restore Plus Hydrocolloid Dressings .......................................104
Restore CalciCare Calcium Alginate ........................................105
Restore Hydrogels..................................................................105
Restore Wound Cleanser ..................................................page 105
Skin Care .........................................................................page 106
Skin Cleanser ........................................................................106
Skin Gel.................................................................................106
Restore Cleanser and Moisturizer............................................106
Petrolatum-Based Barrier Ointment.........................................106
Restore DimethiCreme ...........................................................106
Skin Conditioning Cremes.......................................................106
Odor Management ...........................................................page 107
Odor-Absorbent Dressings: Sterile ..........................................107
Odor Eliminator Spray ............................................................107
Wound Drainage Collectors.............................................pages 108
Wound Drainage Collectors ....................................................108
Universal Catheter Access Port: Sterile....................................108
Tube Management Products ...................................pages 108-109
Oral Endotracheal Tube Attachment Device (ETAD)...................108
Horizontal Tube Attachment Device: Sterile (HTAD)...................109
Vertical Tube Attachment Device: Sterile (VTAD).......................109
Drain Tube Attachment Device (DTAD).....................................109
Feeding Tube Attachment Device (FTAD) .................................109
Suction Tube Attachment Device (STAD)..................................109
Pressure Management............................................pages 110-111
Orthotic Boot .........................................................................110
Accessories - Transfer Soles...................................................110
Replacement Liners ...............................................................110
Heel and Elbow Protectors......................................................111
“Premium” Heel and Elbow Protectors ....................................111
Lifter Foot Elevator.................................................................111
Decubitus Foam Protector ......................................................111
Cannula Tubing Pads..............................................................111
Limb Restraints................................................................page 112
Quick Release Limb Holder.....................................................112
Quilted Limb Holder ...............................................................112
“ER” Restraint........................................................................112
Arm Holder System................................................................112
Body Restraints................................................................page 113
Poncho..................................................................................113
Sleeved Blazer Jacket ............................................................113
ICU Blazer..............................................................................113
Quilted Torso Restraint ...........................................................113
Restraint Alternatives .......................................................page 114
“Grait” Gait Belt .....................................................................114
Johnny Grait Belt ...................................................................114
IV Sleeve ...............................................................................114
Chair Belt .............................................................................114
Educational Resources.......................................................page 115
Protocols ...............................................................................115
Algorithms.............................................................................115
Other Educational Resources..................................................115
Glossary..............................................................................116-118
Stock Number Index ...................................................................119
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Hollister Incorpora ted
Ostomy
Hollister Incorpora ted
8
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Hollister Incorpora ted
Adapt Accessories (continued)......................................pages 44-46
Odor Eliminators & Lubricants....................................................45
Adapt Lubricating Deodorant..................................................45
Odor Eliminator Spray............................................................45
Cleaner/Decrystallizer............................................................46
Ostomy Belt, Drainable Pouch Clamp, and Urostomy
Drain Tube Adapter................................................................46
OTHER OSTOMY PRODUCTS
Two-Piece Pouching Systems.......................................pages 48-55
CenterPointLock...................................................................48-55
One-Piece Pouching Systems.......................................pages 56-65
FirstChoice...........................................................................56-59
Contour I..............................................................................60-61
Karaya 5..............................................................................62-64
Other One-Piece Products..........................................................65
Ostomy Accessories......................................................pages 66-67
Skin Care Products....................................................................66
Irrigation Products......................................................................66
Loop Ostomy Bridge ..................................................................66
Replacement Filters ...................................................................67
Bedside Drainage Collector ........................................................67
Skin Barrier Pastes and Powders................................................67
Karaya Paste.........................................................................67
Karaya Powder......................................................................67
Skin Barriers..............................................................................67
Premium (standard wear) Skin Barrier....................................67
HolliHesive (standard wear) Skin Barrier .................................67
Odor Eliminator Drops................................................................67
Conversion Charts.........................................................pages 68-73
Two-Piece: CenterPointLock to New Image............................69-71
One-Piece: FirstChoice to Premier..............................................72
Old to New Accessories .............................................................73
Discontinued Products..................................................pages 74-77
Glossary for Ostomy Products.......................................pages 78-79
Educational Resources..................................................pages 80-81
Stock Number Index.....................................................pages 82-83
T
able of Contents - Ostomy
Hollister Incorpora ted
Ostomy Table of Contents........................................................10-11
Quick Reference/Product Selection Guides...................pages 12-21
New Image Two-Piece Pouching System Skin Barriers...........12-13
New Image Two-Piece Pouching System Pouches.................14-15
New Image Two-Piece Pouching System Single Use Kits.............16
Premier One-Piece Pouching System Pouches......................18-21
Medicare Utilization Chart .......................................................22-23
New Image Two-Piece Pouching System......................pages 24-33
Skin Barriers ........................................................................24-28
Drainable Pouches ...............................................................28-30
High Output Drainable Pouches..................................................30
Closed Pouches.........................................................................31
Urostomy Pouches ...............................................................31-32
Irrigator Sleeve...........................................................................32
Non-Sterile and Sterile Kits...................................................32-33
Premier One-Piece Pouching System ...........................pages 34-41
Drainable Pouches ...............................................................34-38
Post-Operative Drainable Pouches..............................................38
Closed Pouches.........................................................................39
Urostomy Pouches ..............................................................40-41
Pouchkins Pediatric Pouching Systems.........................pages 42-43
Premie/Newborn Pouch .............................................................42
Drain Tube.................................................................................42
One-Piece Pediatric Pouches................................................42-43
Two-Piece Pediatric Pouches......................................................43
Pediatric Ostomy Belt.................................................................43
Adapt Accessories ........................................................pages 44-46
Skin Barrier Accessories.............................................................44
Adapt Barrier Rings ...............................................................44
Adapt Convex Barrier Rings ...................................................44
Adapt Barrier Strips...............................................................44
Skin Barrier Pastes and Powders................................................44
Adapt Paste ..........................................................................44
Premium Powder...................................................................44
Skin Barriers..............................................................................44
Flextend (extended wear) Skin Barrier ....................................44
Skin Gel Wipes ..........................................................................44
Skin Gel Protective Dressing Wipes........................................45
Adhesives and Removers...........................................................45
Universal Remover Wipes.......................................................45
Medical Adhesive...................................................................45
Medical Adhesive Remover....................................................45
Table of Contents - Ostomy
10
How to Size Hollister Ostomy Pouches
A properly fitted pouch is essential to minimize stomal and skin irrita-
tion and to obtain optimum pouch wear time. A stoma measuring card
allows correct measurement of the stoma.
Measure the stoma accurately. Select the smallest barrier opening
which fits comfortably around the stoma without actually touching it.
Too large an opening will leave skin exposed and could lead to skin
irritation or erosion.
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Hollister Incorpora ted
New Ima
ge
T
wo-Piece Quick Reference
Hollister Incorpora ted
Quick Reference/Product Selection Guide
12
WITH T
APE
WITHOUT
T
APE
WITH T
APE
WITHOUT
T
APE
14202
14203
14204
14206
up to 1-1/4" (32mm)
up to 1-3/4" (44mm)
up to 2-1/4" (57mm)
up to 3-1/2" (89mm)
15202
15203
15204
—
up to 1-1/4" (32mm)
up to 1-3/4" (44mm)
up to 2-1/4" (57mm)
1430
x
1640x
14307
14308
—
—
1-3/8" (35mm)
1-1/2" (38mm)
16407
16408
—
—
1-3/8" (35mm)
1-1/2" (38mm)
FLEXWEAR
FLEXTEND
PRE-SIZED
CUT-TO-FIT
WITH T
APE
WITHOUT
T
APE
PRE-SIZED
CUT-TO-FIT
FLAT BARRIER
WITH T
APE
WITHOUT
T
APE
1-3/4" (44mm)
2-1/4" (57mm)
2-3/4" (70mm)
4" (102mm)
14602
14603
14604
14606
up to 1-1/4" (32mm)
up to 1-3/4" (44mm)
up to 2-1/4" (57mm)
up to 3-1/2" (89mm)
15602
15603
15604
—
up to 1-1/4" (32mm)
up to 1-3/4" (44mm)
up to 2-1/4" (57mm)
1470x
1610x
14707
14708
—
—
1-3/8" (35mm)
1-1/2" (38mm)
16107
16108
—
—
1-3/8" (35mm)
1-1/2" (38mm)
New Image Flat Barriers
WITH T
APE
WITHOUT
T
APE
WITH T
APE
WITHOUT
T
APE
14402
14403
14404
up to 1" (25mm)
up to 1-1/2" (38mm)
up to 2" (51mm)
15402
15403
15404
up to 1" (25mm)
up to 1-1/2" (38mm)
up to 2" (51mm)
FLEXWEAR
FLEXTEND
PRE-SIZED
CUT-TO-FIT
WITH T
APE
WITHOUT
T
APE
PRE-SIZED
CUT-TO-FIT
CONVEX BARRIER
WITH T
APE
WITHOUT
T
APE
1-3/4" (44mm)
2-1/4" (57mm)
2-3/4" (70mm)
14802
14803
14804
up to 1" (25mm)
up to 1-1/2" (38mm)
up to 2" (51mm)
15802 15803 15804
up to 1" (25mm)
up to 1-1/2" (38mm)
up to 2" (51mm)
14903
14904
7/8" (22mm)
1" (25mm)
14905
14906
—
1-1/8" (29mm)
1-1/4" (32mm)
New Image Conve
x Barriers
15903
15904
7/8" (22mm)
1" (25mm)
15905
15906
—
1-1/8" (29mm)
1-1/4" (32mm)
14503
14504
7/8" (22mm)
1" (25mm)
14505
14506
—
1-1/8" (29mm)
1-1/4" (32mm)
15503
15504
7/8" (22mm)
1" (25mm)
15505
15506
—
1-1/8" (29mm)
1-1/4" (32mm)
New Image Two-Piece Flat Skin Barriers with Floating Flange
New Image Two-Piece Convex Skin Barriers with Floating Flange
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Hollister Incorpora ted
New Ima
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T
wo-Piece Quick Reference
Hollister Incorpora ted
Quick Reference/Product Selection Guide
14
TRANSP
ARENT
18162
18163
18164
—
BEIGE
18142
18143
18144
—
TRANSP
ARENT 18102
18103
18104
—
UL
TRA-CLEAR
—
18173
18174
18176
BEIGE
18122
18123
18124
—
POUCH CLAMP
LOCK 'N ROLL
NO
FILTER
FILTER
DRAINABLE
1-3/4" (44mm)
2-1/4" (57mm)
2-3/4" (70mm)
4" (102mm)
TRANSP
ARENT
18192
18292
18193 18293
18194 18294
—
BEIGE
18182
18282
18183
18283
18184
18284
—
TRANSP
ARENT 18132
18133
18134
—
UL
TRA-CLEAR
—
18003
18004
18006
BEIGE
18112
18113
18114
—
HIGH OUTPUT
WITH
SOFT TAP
NO
FILTER
FILTER
NO FILTER
UL
TRA-CLEAR 18012
18013
18014
18016
New Image Drainable P
ouches
7"
9"
(18cm)
(23cm)
FILTER
FILTER
CLOSED
1-3/4" (44mm)
2-1/4" (57mm)
2-3/4" (70mm)
TRANSP
ARENT
18362
18363
18364
BEIGE
18372
18373
18374
TRANSP
ARENT
18382
18383
18384
BEIGE
18392
18393
18394
UROSTOMY
TRANSP
ARENT 18402
18403
18404
UL
TRA-CLEAR
18422
18423
—
BEIGE
18412
18413
18414
New Image Closed P
ouches
New Ima
ge Urostomy P
ouches
9"
(23cm)
New Image Two-Piece Drainable Pouches
New Image Two-Piece Closed and Urostomy Pouches
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Hollister Incorpora ted
Quick Reference/Product Selection Guide
16
UROSTOMY
(FLEXTEND)
DRAINABLE
(FLEXWEAR)
POUCH CLAMP
LOCK 'N ROLL
SINGLE USE KITS
UL
TRA-CLEAR
UL
TRA-CLEAR
UL
TRA-CLEAR
1-3/4" (44mm)
2-1/4" (57mm)
2-3/4" (70mm)
4" (102mm)
—
19003
19004
19006
—
19053
19054
19056
—
19103
19104
19106
—
19153
19154
19156
19202
19203
—
—
19252
19253
—
—
NON-
NON-
NON-
STERILE STERILE
STERILE STERILE
STERILE STERILE
UL
TRA-CLEAR
UL
TRA-CLEAR
UL
TRA-CLEAR
New Ima
ge Single Use Kits
New Image Two-Piece Single Use Kits
No clamp needed!
Plastic fasteners
lock in place so you
canFeel the Seal!
4
3
2
To Seal.(step 4)
Press firmly from the
center to the outer edges
along the closure strip
andFeel the Seal!
To Drain.
Pinch (squeeze) the
sides of the pouch tail.
To Clean.
Clean the inside of the
pouch tail with a tissue.
Lock ’n Roll
Closure System
New Image Two-Piece and Premier
One-Piece Lock ’n Roll Closure System
1
To Close.(steps 1-3)
Fold up pouch tail
three (3) times up
towards the outer side
of the pouch until the
plastic fasteners meet.
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Hollister Incorpora ted
Premier One-Piece Quick Reference
Hollister Incorpora ted
Quick Reference/Product Selection Guide
18
Premier P
ouches
Drainable with Flat Barriers
LOCK 'N ROLL
POUCH CLAMP
LOCK 'N ROLL
12"
7"
12"
9"
(30cm) (18cm)
(30cm) (23cm)
SOFTFLEX,FIL
TER
WITHOUT TAPE
DRAINABLE WITH FLA
T BARRIERS
up to 2-1/2"
3/4"
1"
1-3/16"
1-1/4"
1-3/8"
1-1/2"
1-9/16"
1-3/4"
2"
2-1/2"
(64mm)
(19mm)
(25mm) (30mm) (32mm)
(35mm)
(38mm)
(40mm)
(44mm)
(51mm)
(64mm)
TRANSP
ARENT
—
—
8532
—
8538
—
8533
—
8539
—
—
UL
TRA-CLEAR
8531
—
—
—
—
—
—
—
—
—
—
BEIGE
8551
—
8552
—
8558
—
8553
—
8539
—
—
TRANSP
ARENT
8641
—
—
—
—
—
—
—
—
—
—
BEIGE
—
8647
8642
—
8648
—
8643
—
8649
8644
TRANSP
ARENT 8631
8637
8632
—
8638
—
8633
—
8639
8634
8635
TRANSP
ARENT
88800*
—
88825
88830
—
88835
—
88840
—
—
—
BEIGE
88700*
—
88725
88730
—
88735
—
88740
—
—
—
TRANSP
ARENT 88400*
—
88425
88430
—
88435
—
88440
—
—
—
BEIGE
88300*
—
88325
88330
—
88335
—
88340
—
—
—
FLEXTEND,NO FIL
TER,WITH
TAPE
CUT
-
T
O
-FIT
PRE-SIZED
12" (30cm)
*Cut-to-fit only to 2-1/8" (55mm)
Premier One-Piece Drainable Pouches with Flat Barriers
Premier P
ouches
Drainable with Conve
x Barriers
POUCH CLAMP
LOCK 'N ROLL
12" (30cm)
DRAINABLE WITH CONVEX BARRIERS
up to 1"
up to 1-1/2"
up to 2"
3/4"
7/8"
1"
1-1/8"
1-1/4"
1-3/8"
1-1/2"
1-5/8"
1-3/4"
2"
(25mm)
(38mm)
(51mm)
(19mm)
(22mm) (25mm)
(29mm) (32mm)
(35mm)
(38mm)
(41mm)
(44mm)
(51mm)
TRANSP
ARENT
8524
8528
85211
8510
8511
8512
8513
8514
8515
—
—
—
—
BEIGE
8504
8508
85011
8590
8591
8592
8593
8594
8595
—
—
—
—
TRANSP
ARENT
8624
8628
86211
8610 8611
8612
8613
8614
8615
8616 8617
8618
8619
FLEXTEND,NO FIL
TER,WITH
TAPE
CUT
-
T
O
-FIT
PRE-SIZED
Premier One-Piece Drainable Pouches with Convex Barriers
OWC_spot186-rev v4.0 FINAL 3/29/05 6:51 AM Page 18
Page 11
21
Hollister Incorpora ted
Premier One-Piece Quick Reference
Hollister Incorpora ted
Quick Reference/Product Selection Guide
20
Premier P
ouches
Urostomy
CONVEX
FLAT
TRANSPARENT
TRANSPARENT
PREMIER UROSTOMY POUCHES
up to 1"
up to 1-1/2"
up to 2"
up to 2-1/2"
1/2"
5/8"
3/4"
7/8"
1"
1-1/8" 1-1/4" 1-3/8"
1-1/2" 1-3/4"
2"
(25mm) (38mm)
(51mm)
(64mm)
(13mm)
(15mm)
(19mm) (22mm) (25mm) (29mm) (32mm) (35mm)
(38mm) (44mm)
(51mm)
FLEXTEND WITH TAPE
CUT
-
T
O
-FIT
PRE-SIZED
—
—
—
8460
—
—
8467
—
8462
—
8468
—
8463
8469
8464
8474
8478
84711
—
8480 8481
8482 8483
8484 8485
8486
8487 8488
8489
—
Premier One-Piece Urostomy Pouches
Premier One-Piece Closed Pouches
7"
9"
(18cm)
(23cm)
SOFTFLEX,FIL
TER,
WITHOUT TAPE
CLOSED
TRANSP
ARENT
82400
—
—
—
BEIGE
82300
82325
82330
82335
Premier Closed P
ouches
up to 2-1/8"
1"
1-3/16"
1-3/8"
(55mm)
(25mm)
(30mm)
(35mm)
CUT
-
T
O
-FIT
PRE-SIZED
TRANSP
ARENT
82500
—
—
—
BEIGE
82100
82125
82130
82135
OWC_spot186-rev v4.0 FINAL 3/29/05 6:51 AM Page 20
Page 12
23
Hollister Incorpora ted
Medicare Utiliza
tion
A5063
Ostomy pouch, drainable, for use on barrier with
flange (2 piece), each
20
A5073
Ostomy pouch, urinary, for use on barrier with
20
flange (2 piece), each
A5122
Skin barrier, solid, 8x8 or equivalent, each
20
A5131
Appliance cleaner, incontinence and ostomy
1
appliances, per 16 oz
Code
Description
No./6 Months
A4371
Ostomy skin barrier, powder, per oz.
10
A4398
Ostomy irrigation supply, bag, each
2
A4399
Ostomy irrigation supply, cone/catheter,
2
including brush
A4455
Adhesive remover or solvent (for tape, cement,
16
or other adhesive), per ounce
A5119
Skin barrier, wipes, box per 50
3
Hollister Incorpora ted
Medicare Utilization
22
Medicare’s Usual Maximum Quantity for
Ostomy Supplies
The quantity of ostomy supplies needed by a patient is determined to
a great extent by the type of ostomy, its location, its construction, and
the condition of the skin surface surrounding the stoma. There will be
variation according to individual patient 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 depending on the factors that affect the frequency of
barrier and pouch change. The medical necessity for use of a greater
quantity of supplies than the amounts listed must be clearly docu-
mented in the patient's medical record.
Code
Description
No./Month
A4357
Bedside drainage bag, day or night,
2
with or without anti-reflux device, with or
without tube, each
A4362
Skin barrier, solid, 4x4 or equivalent, each
20
A4364
Adhesive, liquid or equal, any type, per oz
4
A4367
Ostomy belt, each
1
A4397
Irrigation supply, sleeve, each
4
A4402
Lubricant, per ounce
4
A4405
Ostomy skin barrier, non-pectin based, paste,
4
per ounce
A4406
Ostomy skin barrier, pectin-based, paste, per ounce
4
A4414
Ostomy skin barrier, with flange (solid, flexible or
20
accordion), without built-in convexity, 4x4 inches
or smaller, each
A4415
Ostomy skin barrier, with flange (solid, flexible or
20
accordion), without built-in convexity
A4416
Ostomy pouch, closed, with barrier attached, with
60
filter (1 piece), each
A4418
Ostomy pouch, closed, without barrier attached,
60
with filter (1 piece), each
A4419
Ostomy pouch, closed, for use on barrier with
60
non-locking flange, with filter (2 piece), each
A4424
Ostomy pouch, drainable, with barrier
20
attached, with filter (1 piece), each
A4425
Ostomy pouch, drainable, for use on barrier
20
with non-locking flange, with filter (2 piece
system), each
A4429
Ostomy pouch, urinary, with barrier attached, with
20
built-in convexity, with faucet-type tap with valve
(1 piece), each
A4431
Ostomy pouch, urinary, with barrier attached,
20
with faucet-type tap, with valve (1 piece), each
A4432
Ostomy pouch, urinary, for use on barrier with
20
non-locking flange, with faucet-type tap with
valve (2 piece), each
A5051
Ostomy pouch, closed, with barrier attached
60
(1 piece), each
A5052
Ostomy pouch, closed, without barrier attached
60
(1 piece), each
A5055
Stoma Cap
31
A5061
Ostomy pouch, drainable, with barrier attached
20
(1 piece), each
Code
Description
No./Month
OWC_spot186-rev v4.0 FINAL 3/29/05 6:51 AM Page 22
Page 13
25
Hollister Incorpora ted
Flat Skin Barriers with Floating Flanges (continued)
1470x
(PRE-SIZED)
Box of 5
Flextend (extended wear) Skin Barrier - Flat
With Tape Border
HCPCS: A4409
Stock No
Color Match
Flange Size
Barrier Opening
14701
•
1-3/4" (44mm)
5/8" (16mm)
14702
•
1-3/4" (44mm)
3/4" (19mm)
14703
•
1-3/4" (44mm)
7/8" (22mm)
14704
•
1-3/4" (44mm)
1" (25mm)
14705
•
1-3/4" (44mm)
1-1/8" (29mm)
14706
•
1-3/4" (44mm)
1-1/4" (32mm)
14707
•
2-1/4" (57mm)
1-3/8" (35mm)
14708
•
2-1/4" (57mm)
1-1/2" (38mm)
1610x
(PRE-SIZED)
Box of 5
Flextend (extended wear) Skin Barrier - Flat
Without Tape Border
HCPCS: A4409
Stock No
Color Match
Flange Size
Barrier Opening
16101
•
1-3/4" (44mm)
5/8" (16mm)
16102
•
1-3/4" (44mm)
3/4" (19mm)
16103
•
1-3/4" (44mm)
7/8" (22mm)
16104
•
1-3/4" (44mm)
1" (25mm)
16105
•
1-3/4" (44mm)
1-1/8" (29mm)
16106
•
1-3/4" (44mm)
1-1/4" (32mm)
16107
•
2-1/4" (57mm)
1-3/8" (35mm)
16108
•
2-1/4" (57mm)
1-1/2" (38mm)
1430x
(PRE-SIZED)
Box of 5
FlexWear (standard wear) Skin Barrier - Flat
With Tape Border
HCPCS: A4414
Stock No
Color Match
Flange Size
Barrier Opening
14301
•
1-3/4" (44mm)
5/8" (16mm)
14302
•
1-3/4" (44mm)
3/4" (19mm)
14303
•
1-3/4" (44mm)
7/8" (22mm)
14304
•
1-3/4" (44mm)
1" (25mm)
14305
•
1-3/4" (44mm)
1-1/8" (29mm)
14306
•
1-3/4" (44mm)
1-1/4" (32mm)
14307
•
2-1/4" (57mm)
1-3/8" (35mm)
14308
•
2-1/4" (57mm)
1-1/2" (38mm)
1640x
(PRE-SIZED)
Box of 5
FlexWear (standard wear) Skin Barrier - Flat
Without Tape Border
HCPCS: A4414
Stock No
Color Match
Flange Size
Barrier Opening
16401
•
1-3/4" (44mm)
5/8" (16mm)
16402
•
1-3/4" (44mm)
3/4" (19mm)
16403
•
1-3/4" (44mm)
7/8" (22mm)
16404
•
1-3/4" (44mm)
1" (25mm)
16405
•
1-3/4" (44mm)
1-1/8" (29mm)
16406
•
1-3/4" (44mm)
1-1/4" (32mm)
16407
•
2-1/4" (57mm)
1-3/8" (35mm)
16408
•
2-1/4" (57mm)
1-1/2" (38mm)
New Ima
ge
T
wo-Piece P
ouching System
Hollister Incorpora ted
Flat Skin Barriers with Floating Flanges
1460x
(CUT-TO-FIT)
Box of 5
Flextend (extended wear) Skin Barrier - Flat
With Tape Border
HCPCS: A4409
HCPCS for 14606: A4410
Stock No
Color Match
Flange Size
Barrier Opening
14602
•
1-3/4" (44mm)
up to 1-1/4" (32mm)
14603
•
2-1/4" (57mm)
up to 1-3/4" (44mm)
14604
•
2-3/4" (70mm)
up to 2-1/4" (57mm)
14606
**
•
4" (102mm)
up to 3-1/2" (89mm)
1560x
(CUT-TO-FIT)
Box of 5
Flextend (extended wear) Skin Barrier - Flat
Without Tape Border
HCPCS for 15602 & 15603: A4409
HCPCS for 15604: A4410
Stock No
Color Match
Flange Size
Barrier Opening
15602
•
1-3/4" (44mm)
up to 1-1/4" (32mm)
15603
•
2-1/4" (57mm)
up to 1-3/4" (44mm)
15604
•
2-3/4" (70mm)
up to 2-1/4" (57mm)
1420x
(CUT-TO-FIT)
Box of 5
FlexWear (standard wear) Skin Barrier - Flat
With Tape Border
HCPCS: A4414
HCPCS for 14206: A4415
Stock No
Color Match
Flange Size
Barrier Opening
14202
•
1-3/4" (44mm)
up to 1-1/4" (32mm)
14203
•
2-1/4" (57mm)
up to 1-3/4" (44mm)
14204
•
2-3/4" (70mm)
up to 2-1/4" (57mm)
14206
**
•
4" (102mm)
up to 3-1/2" (89mm)
1520x
(CUT-TO-FIT)
Box of 5
FlexWear (standard wear) Skin Barrier - Flat
Without Tape Border
HCPCS for 15202 & 15203: A4414
HCPCS for 15204: A4415
Stock No
Color Match
Flange Size
Barrier Opening
15202
•
1-3/4" (44mm)
up to 1-1/4" (32mm)
15203
•
2-1/4" (57mm)
up to 1-3/4" (44mm)
15204
•
2-3/4" (70mm)
up to 2-1/4" (57mm)
New Image Two-Piece Pouching System
24
NEW!
Color Matching System
To help you select compatible New Image components, every box label
is color-coded. First, select the proper skin barrier; then select a
matching color-coded pouch (“red” skin barrier box label is compatible
to “red” pouch box label).
1-3/4"
(44mm)
2-1/4"
(57mm)
2-3/4"
(70mm)
NEW!
NEW!
NEW!
4"
(102mm)
**coming soon
OWC_spot186-rev v4.0 FINAL 3/29/05 6:51 AM Page 24
Page 14
27
Hollister Incorpora ted
Convex Skin Barriers with Floating Flanges
1480x
(CUT-TO-FIT)
Box of 5
Flextend (extended wear) Skin Barrier - Convex
With Tape Border
HCPCS: A4407
Stock No
Color Match
Flange Size
Barrier Opening
14802
•
1-3/4" (44mm)
up to 1" (25mm)
14803
•
2-1/4" (57mm)
up to 1-1/2" (38mm)
14804
•
2-3/4" (70mm)
up to 2" (51mm)
1580x
(CUT-TO-FIT)
Box of 5
Flextend (extended wear) Skin Barrier - Convex
Without Tape Border
HCPCS for 15802 & 15803: A4407
HCPCS for 15804: A4408
Stock No
Color Match
Flange Size
Barrier Opening
15802
•
1-3/4" (44mm)
up to 1" (25mm)
15803
•
2-1/4" (57mm)
up to 1-1/2" (38mm)
15804
•
2-3/4" (70mm)
up to 2" (51mm)
1440x
(CUT-TO-FIT)
Box of 5
FlexWear (standard wear) Skin Barrier - Convex
With Tape Border
HCPCS: A4373
Stock No
Color Match
Flange Size
Barrier Opening
14402
•
1-3/4" (44mm)
up to 1" (25mm)
14403
•
2-1/4" (57mm)
up to 1-1/2" (38mm)
14404
•
2-3/4" (70mm)
up to 2" (51mm)
1540x
(CUT-TO-FIT)
Box of 5
FlexWear (standard wear) Skin Barrier - Convex
Without Tape Border
HCPCS: A4373
Stock No
Color Match
Flange Size
Barrier Opening
15402
•
1-3/4" (44mm)
up to 1" (25mm)
15403
•
2-1/4" (57mm)
up to 1-1/2" (38mm)
15404
•
2-3/4" (70mm)
up to 2" (51mm)
1490x
(PRE-SIZED)
Box of 5
Flextend (extended wear) Skin Barrier - Convex
With Tape Border
HCPCS: A4407
Stock No
Color Match
Flange Size
Barrier Opening
14903
•
1-3/4" (44mm)
7/8" (22mm)
14904
•
1-3/4" (44mm)
1" (25mm)
14905
•
2-1/4" (57mm)
1-1/8" (29mm)
14906
•
2-1/4" (57mm)
1-1/4" (32mm)
New Ima
ge
T
wo-Piece P
ouching System
Hollister Incorpora ted
Flat Skin Barriers with Stationary Flanges
1660x
*
(CUT-TO-FIT)
Box of 5
Flextend (extended wear) Skin Barrier - Flat
Without Tape Border
HCPCS for 16602 & 16603: A4409
HCPCS for 16604: A4410
Stock No
Color Match
Flange Size
Barrier Opening
16602
•
1-3/4" (44mm)
up to 1-1/2" (38mm)
16603
•
2-1/4" (57mm)
up to 2" (50mm)
16604
•
2-3/4" (70mm)
up to 2-1/2" (63mm)
1620x
*
(CUT-TO-FIT)
Box of 5
FlexWear (standard wear) Skin Barrier - Flat
Without Tape Border
HCPCS for 16202 & 16203: A4414
HCPCS for 16204: A4415
Stock No
Color Match
Flange Size
Barrier Opening
16202
•
1-3/4" (44mm)
up to 1-1/2" (38mm)
16203
•
2-1/4" (57mm)
up to 2" (50mm)
16204
•
2-3/4" (70mm)
up to 2-1/2" (63mm)
1670x
*
(PRE-SIZED)
Box of 5
Flextend (extended wear) Skin Barrier - Flat
Without Tape Border
HCPCS: A4409
Stock No
Color Match
Flange Size
Barrier Opening
16701
•
1-3/4" (44mm)
5/8" (16mm)
16702
•
1-3/4" (44mm)
3/4" (19mm)
16703
•
1-3/4" (44mm)
7/8" (22mm)
16704
•
1-3/4" (44mm)
1" (25mm)
16705
•
1-3/4" (44mm)
1-1/8" (29mm)
16706
•
1-3/4" (44mm)
1-1/4" (32mm)
16707
•
1-3/4" (44mm)
1-3/8" (35mm)
16708
•
1-3/4" (44mm)
1-1/2" (38mm)
1630x
*
(PRE-SIZED)
Box of 5
FlexWear (standard wear) Skin Barrier - Flat
Without Tape Border
HCPCS: A4414
Stock No
Color Match
Flange Size
Barrier Opening
16301
•
1-3/4" (44mm)
5/8" (16mm)
16302
•
1-3/4" (44mm)
3/4" (19mm)
16303
•
1-3/4" (44mm)
7/8" (22mm)
16304
•
1-3/4" (44mm)
1" (25mm)
16305
•
1-3/4" (44mm)
1-1/8" (29mm)
16306
•
1-3/4" (44mm)
1-1/4" (32mm)
16307
•
1-3/4" (44mm)
1-3/8" (35mm)
16308
•
1-3/4" (44mm)
1-1/2" (38mm)
New Image Two-Piece Pouching System
26
*plan to discontinue by 6-30-05
CONVEX PRODUCT
For Your Information
Place skin barriers on body as a diamond shape to prevent edges from rolling.
Do not use Skin Gel Wipes or other brands of skin preps with Flextend skin barriers.
NEW!
NEW!
NEW!
OWC_spot186-rev v4.0 FINAL 3/29/05 6:51 AM Page 26
Page 15
29
Hollister Incorpora ted
Drainable Pouches (continued)
1828x/1829x
Box of 20
Drainable Mini-Pouch
With Integrated Filter
Lock ’n Roll Closure
Odor-Barrier Rustle-Free Film
With ComfortWear Panels
- Transparent = body side only
- Beige = both sides
HCPCS: A4425
Transparent
Beige
Color
Flange
Pouch
Stock No
Stock No
Match
Size
Length
18292
18282
•
1-3/4" (44mm)
7" (18cm)
18293
18283
•
2-1/4" (57mm)
7" (18cm)
18294
18284
•
2-3/4" (70mm)
7" (18cm)
1811x/1813x
Box of 10
Drainable Pouch
Without Integrated Filter
Lock ’n Roll Closure
Odor-Barrier Rustle-Free Film
With ComfortWear Panels
- Transparent = body side only
- Beige = both sides
HCPCS: A5063
Transparent.
Beige
Color
Flange
Pouch
Stock No
Stock No
Match
Size
Length
18132
18112
•
1-3/4" (44mm)
12" (30cm)
18133
18113
•
2-1/4" (57mm)
12" (30cm)
18134
18114
•
2-3/4" (70mm)
12" (30cm)
1800x
Box of 10
Drainable Pouch
Without Integrated Filter
Lock ’n Roll Closure
Odor-Barrier Film
With ComfortWear Panels
- Ultra-Clear = body side only
HCPCS: A5063
Ultra-Clear
Color
Flange
Pouch
Stock No
Match
Size
Length
18003
•
2-1/4" (57mm)
12" (30cm)
18004
•
2-3/4" (70mm)
12" (30cm)
18006
•
4" (102mm)
12" (30cm)
1814x/1816x
Box of 10
Drainable Pouch
With Integrated Filter
Pouch Clamp Closure
Odor-Barrier Rustle-Free Film
With ComfortWear Panels
- Transparent = body side only
- Beige = both sides
HCPCS: A4425
Transparent
Beige
Color
Flange
Pouch
Stock No
Stock No
Match
Size
Length
18162
18142
•
1-3/4" (44mm)
12" (30cm)
18163
18143
•
2-1/4" (57mm)
12" (30cm)
18164
18144
•
2-3/4" (70mm)
12" (30cm)
Coming
Soon!
New Ima
ge
T
wo-Piece P
ouching System
Hollister Incorpora ted
Convex Skin Barriers with Floating Flanges (continued)
1590x
(PRE-SIZED)
|
