Home | About Us | Contact Us
Hablamos Espanol
1.800.863.9780
Medicare Part B Ostomy Allowable Guidelines Customer Center|Our Products|Our Services|Medicare Information
Indications and Limitations of Coverage
For any item to be coverd by Medicare it must:
  1. Be eligible for a defined Medicare benefit catagory
  2. Be reasonable and necessary for the diagnosis or treatment of illness or injury, or to improve the functioning of a malformed body member
  3. Meet all other applicable Medicare statutory and regulatory requirements
The quantity of ostomy supplies needed is determined primarily by:
  • Type of ostomy
  • Location of ostomy
  • Construction of ostomy
  • Condition of the skin surface surrounding the stoma
There will be variations according to each individual, and the needs may vary over time. The table below lists the maximun number of items.units of service that are usually medically necessary. The actual quantity needed for a particulat individual 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 that the amounts listed must be clearly documented in teh Medicare's Member Medical Record. If adequate documentation is not provided, the extra quantities will be denied as not medically necessary.
 
Ostomy Accessory
Billing CodeProduct Name (click product name to view details)ManufacturerMax UnitsInterval
A4367Assura Ostomy Belt, AdjustableColoplast 1 31 month(s)
A4367SUR-FIT Ostomy Belt, PediatricConvatec 1 31 month(s)
A4367Ostomy Appliance BeltConvatec 1 31 month(s)
A4367Ostomy Belt, AdjustableGenairex 1 31 month(s)
A4367Pouchkins Ostomy Belt, Pediatric, AdjustableHollister 1 31 month(s)
A4367Ostomy BeltHollister 1 31 month(s)
A4396Ostomy Support Belt, 3"Nu-hope Laboratories, Inc. 4 31 month(s)
A5082Coloplast Continent Urinary Pouch Catheter, 16" Funnel EndMentor 1 31 month(s)
A4363Pouch Clamp. WhiteColoplast As Prescribed 31 month(s)
A4363DuoLock Curved Tail Closure. BeigeConvatec As Prescribed 31 month(s)
A4363VISI-FLOW Irrigation Sleeve Tail ClosureConvatec As Prescribed 31 month(s)
A4363Securi-T Curved Tail ClosureGenairex As Prescribed 31 month(s)
A4363Clamp for Drainable Pouch, BeigeHollister As Prescribed 31 month(s)
A5093Securi-T Convex InsertsGenairex 10 31 month(s)
A4361Visi-Flow Irrigation Adapter FaceplateConvatec 3 186 month(s)
A4400Colopast Irrigation setColoplast As Prescribed 31 month(s)
A5055Securi-T Stoma Cap with Filter, 4". OpaqueGenairex 31 31 month(s)
Ostomy Flange Convex
Billing CodeProduct Name (click product name to view details)ManufacturerMax UnitsInterval
A4373New Image Two Piece Convex Skin Barrier with Floating Flange Series #1440xHollister As Prescribed 31 month(s)
A4407Securi-T Extended Wear Flexible Skin Barrier with Convexity and FlangeGenairex As Prescribed 31 month(s)
A4407New Image Flextend Convex Skin Barrier with Floating FlangeHollister As Prescribed 31 month(s)
Ostomy Flange Nonconvex
Billing CodeProduct Name (click product name to view details)ManufacturerMax UnitsInterval
A4414Sensura NON-CONVEX Click Standard Wear Barrier with Belt TabsColoplast 20 31 month(s)
A4414Little Ones Two-Piece Adhesive Coupling Technology Standard Flexible Skin BarrierConvatec 20 31 month(s)
A4414Securi-T Cut-to-Fit Flexible Skin Barrier with FlangeGenairex 20 31 month(s)
A4414Securi-T Pre-cut Stoma Opening BarrierGenairex 20 31 month(s)
A4414New Image Cut to Fit FlexWear Flat Skin Barrier with Floating FlangeHollister 20 31 month(s)
Ostomy Irrigation
Billing CodeProduct Name (click product name to view details)ManufacturerMax UnitsInterval
A4399Coloplast/Mentor, Insertion TubeColoplast 2 186 month(s)
A4399Coloplast/Mentor, Cone TipColoplast 2 186 month(s)
A4399Coloplast/Mentor, Laird Tip, 1/2" - 1" Tapered, Soft ConeColoplast 2 186 month(s)
A4399Convatec, Visi-Flow Stoma ConeConvatec 2 186 month(s)
A4398Allegiance Disposable Enema BagAllegiance 2 186 month(s)
A4398Coloplast, Enema Bag with Catheter and TubingColoplast 2 186 month(s)
A4398Hollister Cone Irrigator Kit Part 1Hollister 2 186 month(s)
A4397Bard, Ostomy Irrigating SleeveBard Medical Division 10 31 month(s)
Ostomy Pouch 1 Piece
Billing CodeProduct Name (click product name to view details)ManufacturerMax UnitsInterval
A4416Sensura One-Piece NON-Convex Standard Wear Closed PouchColoplast 60 31 month(s)
A4416Premier One-Piece Closed Pouch Series BeigeHollister 60 31 month(s)
A4388Securi-T 12" One-Piece Extended Wear Drainable Pouch. OpaqueGenairex As Prescribed 31 month(s)
A4390Premier One-Piece Lock n Roll Drainable Pouch with Convex Skin Barrier. TransparentHollister As Prescribed 31 month(s)
A5071Pouchkins One-Piece Infant Pouch.Hollister 20 31 month(s)
A4391Nu-Flex Trim to Fit Mini One-Piece PouchNu-hope Laboratories, Inc. As Prescribed 31 month(s)
A4430Securi-T 10" One-Piece Urostomy PouchGenairex As Prescribed 31 month(s)
A4430Premier One-Piece Urostomy Pouch with. TransparentHollister As Prescribed 31 month(s)
A4428Premier One-Piece Urostomy Pouch with Flat Barrier. BeigeHollister As Prescribed 31 month(s)
A4392Assura One-Piece Urostomy Pouch with Belt Loops. TransparentColoplast As Prescribed 31 month(s)
A4392Assura One-Piece CONVEX LIGHT Urostomy Multi-Chamber Pouch. TransparentColoplast As Prescribed 31 month(s)
Ostomy Pouch 2 Piece
Billing CodeProduct Name (click product name to view details)ManufacturerMax UnitsInterval
A4423Assura Two-Piece Small Closed Pouch. TransparentColoplast 60 31 month(s)
A4423SenSura Click Closed Pouch, MidiColoplast 60 31 month(s)
A4419CenterPointLock Two-Piece Closed Pouch. WhiteHollister 60 31 month(s)
A4419New Image Two-Piece Closed Pouch. TransparentHollister 60 31 month(s)
A5054Securi-T Two-Piece 8" Closed Pouch without filter. OpaqueGenairex 60 31 month(s)
A4427SenSura Click EasiClose WIDE Outlet Drainable Pouch, MidiColoplast 20 31 month(s)
A4425SUR-FIT Natura Drainable Pouch with InvisiClose Outlet and Filter. OpaqueConvatec 20 31 month(s)
A4425SUR-FIT Natura Drainable Pouch with InvisiClose Outlet and filter. TransparentConvatec 20 31 month(s)
A4425Securi-T 12" Drainable Pouch, Transparent with Filter, 1-sided Comfort PanelGenairex 20 31 month(s)
A4413Assura Two-Piece High Output Drainable Pouch. TransparentColoplast As Prescribed 31 month(s)
A4413Assura Two-Piece High Output Drainable Pouch. OpaqueColoplast As Prescribed 31 month(s)
A5063SUR-FIT Natura 12" Drainable Pouch 1-Sided. OpaqueConvatec 20 31 month(s)
A5063SUR-FIT Natura 10" Drainable Pouch. OpaqueConvatec 20 31 month(s)
A5063New Image Two-Piece Drainable Pouch. BeigeHollister 20 31 month(s)
A5063CenterPointLock Two-Piece Drainable Pouch. OpaqueHollister 20 31 month(s)
A5063New Image Two-Piece Drainable Pouch. OpaqueHollister 20 31 month(s)
A4432New Image Two-Piece Urostomy Pouch. BeigeHollister 20 31 month(s)
A4432New Image Two-Piece Urostomy Pouch. OpaqueHollister 20 31 month(s)
Ostomy Skin Barrier
Billing CodeProduct Name (click product name to view details)ManufacturerMax UnitsInterval
A4369Skin Barrier Prep, 2 oz.Coloplast 2 31 month(s)
A4406Securi-T Stoma Paste, 2 oz.Genairex 4 31 month(s)
A4362Securi-T Hydrocolloid Skin BarrierGenairex As Prescribed 31 month(s)
A4385Securi-T Conformable Seals, 4"Genairex As Prescribed 31 month(s)

UroMed Home | Customer Center |  Employee Login
McAfee Secure sites help keep you safe from identity theft, credit card fraud, spyware, spam, viruses and online scams
Disclaimer | Privacy Notice | Contact Us | About Us
2009 UroMed, Inc. - All Rights Reserved
310109