fee schedule 2009 new - DE Medical Assistance Program

A4433 3 URINE OST PCH BAR W LOCK FLN 3.34
A4434 3 OST PCH URINE W LOCK FLNG/FT 3.76
A4450 3 NON-WATERPROOF TAPE 0.09
A4452 3 WATERPROOF TAPE 0.36
A4454 O TAPE ALL TYPES ALL SIZES 0.00
A4455 3 ADHESIVE REMOVER PER OUNCE 1.33
A4458 5 REUSABLE ENEMA BAG 0.00
A4460 O ELASTIC COMPRESSION BANDAGE 0.00
A4461 6 SURGICL DRESS HOLD NON-REUSE 0.00
A4462 O ABDMNL DRSSNG HOLDER/BINDER 0.00
A4463 6 SURGICAL DRESS HOLDER REUSE 0.00
A4464 O JOINT SUPPORT DEVICE/GARMENT 0.00
A4465 9 NON-ELASTIC EXTREMITY BINDER 0.00
A4470 5 GRAVLEE JET WASHER 0.00
A4480 3 VABRA ASPIRATOR 20.00
A4481 9 TRACHEOSTOMA FILTER 0.00
A4483 3 MOISTURE EXCHANGER 2.86
A4490 3 ABOVE KNEE SURGICAL STOCKING 60.00
A4495 3 THIGH LENGTH SURG STOCKING 60.00
A4500 3 BELOW KNEE SURGICAL STOCKING 30.00
A4510 3 FULL LENGTH SURG STOCKING 60.00
A4520 9 INCONTINENCE GARMENT ANYTYPE 0.00
A4521 O ADULT SIZE DIAPER SM EACH 0.00
A4522 O ADULT SIZE DIAPER MED EACH 0.00
A4523 O ADULT SIZE DIAPER LG EACH 0.00
A4524 O ADULT SIZE DIAPER XL EACH 0.00
A4525 O ADULT SIZE BRIEF SM EACH 0.00
A4526 O ADULT SIZE BRIEF MED EACH 0.00
A4527 O ADULT SIZE BRIEF LG EACH 0.00
A4528 O ADULT SIZE BRIEF XL EACH 0.00
A4529 O CHILD SIZE DIAPER SM/MED EA 0.00
A4530 O CHILD SIZE DIAPER LG EACH 0.00
A4531 O CHILD SIZE BRIEF SM/MED EACH 0.00
A4532 O CHILD SIZE BRIEF LG EACH 0.00
A4533 O YOUTH SIZE DIAPER EACH 0.00
A4534 9 YOUTH SIZE BRIEF EACH 0.00
A4535 O DISP INCONT LINER/SHIELD EA 0.00
A4536 O PROT UNDERWR WSHBL ANY SZ EA 0.00
A4537 O UNDER PAD REUSABLE ANY SZ EA 0.00
A4538 O REUSABLE DIAPER FROM DPR SVC 0.00
A4550 9 SURGICAL TRAYS 0.00
A4554 3 DISPOSABLE UNDERPADS 0.20
A4555 9 PRIMARY SURGICAL DRESSING KIT, (E.G 0.00
A4556 5 ELECTRODES, PAIR 0.00
A4557 3 LEAD WIRES, PAIR 17.16
A4558 3 CONDUCTIVE GEL OR PASTE 4.44
A4559 9 COUPLING GEL OR PASTE 0.00
A4560 O PESSARY 0.00
A4561 3 PESSARY RUBBER, ANY TYPE 17.78
A4562 3 PESSARY, NON RUBBER,ANY TYPE 44.25