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The quantity of ostomy supplies needed 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 needs which may vary over time.
Here are some examples of the current usual maximum quantity for commonly used ostomy products:
- Closed Pouches - 60 pouches per month
- Drainable Pouches with filter - 20 pouches per month
- Ostomy Paste - 2 two-ounce tubes per month
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| Some products do not have a designated usual maximum monthly quantity such as Adapt Lubricating Deodorant, but are still generally covered by reimbursement. |
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| The link below lists the maximum number of items/units of service that are usually medically necessary. |
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| The actual quantity needed 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 documented
in the medical record. |
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| Many private insurance plans and state-run Medicaid programs have similar reimbursement schedules. For further information please contact Hollister's Consumer Programs at 1-888-740-8999. |
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Medicare's Usual Maximum Quantity for Ostomy Supplies  (28 KB - 3 pages) |
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| HCPCS CODE 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 this catalog.
This information is designed as a guideline only. |
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| HCPCS codes shown in this Product Catalog are effective 1-1-08. |
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EXPLANATION OF THIRD PARTY CODE REIMBURSEMENT SYSTEM
(National Health Related Items Code) |
| 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's labeler code, and the last six numbers represent the product stock number. The labeler code for Hollister Incorporated is 08380. In order to utilize this coding system, follow these examples. |
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To code a four-digit stock number:
The Third Party Reimbursement Number for the Premier Drainable Pouch, Stock Number 8531 is: 08380-0085-31
- 08380 identifies Hollister Incorporated
- 0085-31 identifies the product Stock Number
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To code a five-digit stock number:
The Third Party Reimbursement Number for the New Image Closed Pouch Stock Number 18373 is: 08380-0183-73
- 08380 identifies Hollister Incorporated
- 0183-73 identifies the product Stock Number
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