Specific Coverage Policy: Supplies used in the management of incontinence, including creams, salves, lotions, barriers (liquid, spray, wipes, powder, paste) or other skin care products are non-covered by the DMERC.
| Product #
|
NDC Number
|
Description
|
Bottles/Case
|
HCPCS Code
|
| 59430400 | 50484-304-00 | 8 fl.oz. Spray Bottle | 24 | A9270 |
| 59430500 | 50484-305-00 | 1 Gallon Bottle | 4 | A9270 |