Antiseptic
Flammable Keep Away From Fire or Flame. Do not use with electrocautery procedures. For external use only. Do not use in or near the eyes. Discontinue use if irritation or redness develop. If condition persists for more than 72 hours, consult a physician.
Usual Allowable Amount: Liquid skin barrier wipes: 3 boxes of 50 per 6 months. Adhesive remover: 16 oz. per 6 months. Tape: 20 units (360 sq. in.) per month. (Note: a unit is based on 1 in. wide tape.)
Specific Coverage Criteria: Covered with any type of ostomy.
| Product # | Size | Pcs/Pkg | Pkgs/Case | HCPCS Code |
| 59421200 | Wipes | 50 | 20 | A4245 |