Dynamic List Information
Dynamic List Data
HCPCS Code
A4393
On Master List?
Yes
Prior Authorization Required?
No
PA Effective Dates
N/A
F2F and Written Order Prior to Delivery?
No
F2F and WOPD Effective Dates
N/A
Description: Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each