| HCPCS Code: |
A4391 |
| Long Description: |
Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each |
| Short Description: |
Urinary pouch w ex wear barr |
| Pricing Indicator 1: |
37 (Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)) |
| Multiple Pricing Code: |
A (Not applicable as HCPCS priced under one methodology) |
| MCM Reference Section Number 1: |
2130 |
| Statute Number: |
|
| Coverage Code: |
D (Special coverage instructions apply) |
| ASC Payment Group Code: |
|
| Processing Note Number: |
|
| Berenson-Eggers Type of Service (BETOS) Code: |
D1F (Orthotic devices) |
| Type of Service Code 1: |
P (Lump sum purchase of DME, prosthetics, orthotics) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-01-2000 |
| Action Effective Date: |
01-01-2003 |
| Action Code: |
N (No maintenance for this code) |
