Dynamic List Information
Dynamic List Data
HCPCS Code
A5057
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, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each