|
A4206 | Syringe with needle, sterile, 1 cc or less, each |
|
A4207 | Syringe with needle, sterile 2 cc, each |
|
A4208 | Syringe with needle, sterile 3 cc, each |
|
A4209 | Syringe with needle, sterile 5 cc or greater, each |
|
A4210 | Needle-free injection device, each |
|
A4211 | Supplies for self-administered injections |
|
A4212 | Non-coring needle or stylet with or without catheter |
|
A4213 | Syringe, sterile, 20 cc or greater, each |
|
A4215 | Needle, sterile, any size, each |
|
A4216 | Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
|
A4217 | Sterile water/saline, 500 ml |
|
A4218 | Sterile saline or water, metered dose dispenser, 10 ml |
|
A4220 | Refill kit for implantable infusion pump |
|
A4221 | Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
|
A4222 | Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
|
A4223 | Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
|
A4224 | Supplies for maintenance of insulin infusion catheter, per week |
|
A4225 | Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
|
A4230 | Infusion set for external insulin pump, non needle cannula type |
|
A4231 | Infusion set for external insulin pump, needle type |
|
A4232 | Syringe with needle for external insulin pump, sterile, 3 cc |
|
A4233 | Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each |
|
A4234 | Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each |
|
A4235 | Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each |
|
A4236 | Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each |
|
A4244 | Alcohol or peroxide, per pint |
|
A4245 | Alcohol wipes, per box |
|
A4246 | Betadine or phisohex solution, per pint |
|
A4247 | Betadine or iodine swabs/wipes, per box |
|
A4248 | Chlorhexidine containing antiseptic, 1 ml |
|
A4250 | Urine test or reagent strips or tablets (100 tablets or strips) |
|
A4252 | Blood ketone test or reagent strip, each |
|
A4253 | Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
|
A4255 | Platforms for home blood glucose monitor, 50 per box |
|
A4256 | Normal, low and high calibrator solution / chips |
|
A4257 | Replacement lens shield cartridge for use with laser skin piercing device, each |
|
A4258 | Spring-powered device for lancet, each |
|
A4259 | Lancets, per box of 100 |
|
A4261 | Cervical cap for contraceptive use |
|
A4262 | Temporary, absorbable lacrimal duct implant, each |
|
A4263 | Permanent, long term, non-dissolvable lacrimal duct implant, each |
|
A4264 | Permanent implantable contraceptive intratubal occlusion device(s) and delivery system |
|
A4265 | Paraffin, per pound |
|
A4266 | Diaphragm for contraceptive use |
|
A4267 | Contraceptive supply, condom, male, each |
|
A4268 | Contraceptive supply, condom, female, each |
|
A4270 | Disposable endoscope sheath, each |
|
A4280 | Adhesive skin support attachment for use with external breast prosthesis, each |
|
A4281 | Tubing for breast pump, replacement |
|
A4282 | Adapter for breast pump, replacement |
|
A4283 | Cap for breast pump bottle, replacement |
|
A4284 | Breast shield and splash protector for use with breast pump, replacement |
|
A4285 | Polycarbonate bottle for use with breast pump, replacement |
|
A4286 | Locking ring for breast pump, replacement |
|
A4290 | Sacral nerve stimulation test lead, each |
