Supplies For Radiologic Procedures
A4641
Radiopharmaceutical, diagnostic, not otherwise classified
A4642
Indium In-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries
A4648
Tissue marker, implantable, any type, each
A4649
Surgical supply; miscellaneous
A4650
Implantable radiation dosimeter, each
A4651
Calibrated microcapillary tube, each
A4652
Microcapillary tube sealant
A4653
Peritoneal dialysis catheter anchoring device, belt, each
A4657
Syringe, with or without needle, each
A4660
Sphygmomanometer/blood pressure apparatus with cuff and stethoscope
A4663
Blood pressure cuff only
A4670
Automatic blood pressure monitor
A4671
Disposable cycler set used with cycler dialysis machine, each
A4672
Drainage extension line, sterile, for dialysis, each
A4673
Extension line with easy lock connectors, used with dialysis
A4674
Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per 8 oz
A4680
Activated carbon filter for hemodialysis, each
A4690
Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each
A4706
Bicarbonate concentrate, solution, for hemodialysis, per gallon
A4707
Bicarbonate concentrate, powder, for hemodialysis, per packet
A4708
Acetate concentrate solution, for hemodialysis, per gallon
A4709
Acid concentrate, solution, for hemodialysis, per gallon
A4714
Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon
A4719
“Y set” tubing for peritoneal dialysis
A4720
Dialysate solution, any concentration of dextrose, fluid volume greater than 249cc, but less than or equal to 999cc, for peritoneal dialysis
A4721
Dialysate solution, any concentration of dextrose, fluid volume greater than 999cc but less than or equal to 1999cc, for peritoneal dialysis
A4722
Dialysate solution, any concentration of dextrose, fluid volume greater than 1999cc but less than or equal to 2999cc, for peritoneal dialysis
A4723
Dialysate solution, any concentration of dextrose, fluid volume greater than 2999cc but less than or equal to 3999cc, for peritoneal dialysis
A4724
Dialysate solution, any concentration of dextrose, fluid volume greater than 3999cc but less than or equal to 4999cc, for peritoneal dialysis
A4725
Dialysate solution, any concentration of dextrose, fluid volume greater than 4999cc but less than or equal to 5999cc, for peritoneal dialysis
A4726
Dialysate solution, any concentration of dextrose, fluid volume greater than 5999cc, for peritoneal dialysis
A4728
Dialysate solution, non-dextrose containing, 500 ml
A4730
Fistula cannulation set for hemodialysis, each
A4736
Topical anesthetic, for dialysis, per gram
A4737
Injectable anesthetic, for dialysis, per 10 ml
A4740
Shunt accessory, for hemodialysis, any type, each
A4750
Blood tubing, arterial or venous, for hemodialysis, each
A4755
Blood tubing, arterial and venous combined, for hemodialysis, each
A4760
Dialysate solution test kit, for peritoneal dialysis, any type, each
A4765
Dialysate concentrate, powder, additive for peritoneal dialysis, per packet
A4766
Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml
A4770
Blood collection tube, vacuum, for dialysis, per 50
A4771
Serum clotting time tube, for dialysis, per 50
A4772
Blood glucose test strips, for dialysis, per 50
A4773
Occult blood test strips, for dialysis, per 50
A4774
Ammonia test strips, for dialysis, per 50
A4802
Protamine sulfate, for hemodialysis, per 50 mg
A4860
Disposable catheter tips for peritoneal dialysis, per 10
A4870
Plumbing and/or electrical work for home hemodialysis equipment
A4890
Contracts, repair and maintenance, for hemodialysis equipment
A4911
Drain bag/bottle, for dialysis, each
A4913
Miscellaneous dialysis supplies, not otherwise specified
A4918
Venous pressure clamp, for hemodialysis, each
A4927
Gloves, non-sterile, per 100
A4928
Surgical mask, per 20
A4929
Tourniquet for dialysis, each
A4930
Gloves, sterile, per pair
A4931
Oral thermometer, reusable, any type, each
A4932
Rectal thermometer, reusable, any type, each
Additional Ostomy Supplies
A5051
Ostomy pouch, closed; with barrier attached (1 piece), each
A5052
Ostomy pouch, closed; without barrier attached (1 piece), each
A5053
Ostomy pouch, closed; for use on faceplate, each
A5054
Ostomy pouch, closed; for use on barrier with flange (2 piece), each
A5055
Stoma cap
A5056
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each
A5057
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each
A5061
Ostomy pouch, drainable; with barrier attached, (1 piece), each
A5062
Ostomy pouch, drainable; without barrier attached (1 piece), each
A5063
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each
A5071
Ostomy pouch, urinary; with barrier attached (1 piece), each
A5072
Ostomy pouch, urinary; without barrier attached (1 piece), each
A5073
Ostomy pouch, urinary; for use on barrier with flange (2 piece), each
A5081
Stoma plug or seal, any type
A5082
Continent device; catheter for continent stoma
A5083
Continent device, stoma absorptive cover for continent stoma
A5093
Ostomy accessory; convex insert
Additional Incontinence Appliances/Supplies
A5102
Bedside drainage bottle with or without tubing, rigid or expandable, each
A5105
Urinary suspensory with leg bag, with or without tube, each
A5112
Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each
A5113
Leg strap; latex, replacement only, per set
A5114
Leg strap; foam or fabric, replacement only, per set
Supplies For Either Incontinence Or Ostomy Appliances
A5120
Skin barrier, wipes or swabs, each
A5121
Skin barrier; solid, 6 x 6 or equivalent, each
A5122
Skin barrier; solid, 8 x 8 or equivalent, each
A5126
Adhesive or non-adhesive; disk or foam pad
A5131
Appliance cleaner, incontinence and ostomy appliances, per 16 oz.
A5200
Percutaneous catheter/tube anchoring device, adhesive skin attachment
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