HCPCS Codes for Products from Halyard Health Respiratory Health
Closed Suction Systems and Respiratory Accessories
CATALOG
NUMBER
DESCRIPTION
UNIT OF
MEAS.
QTY/
UOM
HCPCS
HALYARD* CLOSED SUCTION SYSTEMS FOR ADULTS
220135
2201358
2205
21513511
2155
2105
215135
14Fr, Tracheostomy, Clear T-Piece, Swivel Adapter (size 4.6mm, length 12in/30.5cm)
14Fr, Tracheostomy, Clear T-Piece, MDI, Swivel Adapter (size 4.6mm, length 12in/30.5cm)
14Fr, Clear T-Piece (size 4.6mm, length 21.3in/54cm)
12Fr, Tracheostomy
12Fr (Purple)
10Fr, Clear T-Piece (size 3.3mm, length 21.3in/54cm)
12Fr, Tracheostomy w/Swivel
Case
Case
Case
Case
Case
Case
Case
20
20
20
20
20
20
20
A4605
A4605
A4605
A4605
A4605
A4605
A4605
Case
20
A4605
Case
Case
Case
20
20
20
A4605
A4605
A4605
Case
20
A4605
Case
Case
20
20
A4605
A4605
HALYARD* CLOSED SUCTION SYSTEM CATHETER - WET PAK*
22012356
2208162
220866
22108130
22056
14Fr, Tracheostomy Wet Pak*, Artificial Nose Adapter, Swivel Adapter (size 4.6mm, length
12in/30.5cm)
14Fr, Wet Pak* 6 Vials, MDI (size 4.6mm, length 21.3in/54cm)
14Fr, Wet Pak* (8 Vials), Swivel Adapter (size 4.6mm, length 21.3in/54cm)
14Fr, Wet Pak* (8 Vials), DSE, Ready Care* Oral Suction System (6 Probes), 8 foot Suction
Tubing (size 4.6mm, length 21.3in/54cm)
14Fr, Clear T-Piece, Wet Pak* (size 4.6mm, length 21.3in/54cm)
HALYARD* CLOSED SUCTION CATHETER - ELBOW
22113
221136
14Fr, Tracheostomy, Elbow, Swivel Adapter (size 4.6mm, length 12in/30.5cm)
14Fr, Tracheostomy, Wet Pak*, Elbow, Swivel Adapter (size 4.6mm, length 12in/30.5cm)
*Registered Trademark or Trademark of Halyard Health, Inc., or its affiliates. © 2016 HYH. All rights reserved
CATALOG
NUMBER
DESCRIPTION
UNIT OF
MEAS.
QTY/
UOM
HCPCS
HALYARD* CLOSED SUCTION CATHETER - DOUBLE SWIVEL ELBOW (DSE)
21603
2210
22103
0105-06
0105-12
221036
221038
22106
22108
12Fr, Tracheostomy, DSE (size 4.0mm, length 12in/30.5cm)
14Fr, DSE (size 4.6mm, length 21.3in/54cm)
14Fr, Tracheostomy, DSE (size 4.6mm, length 12in/30.5cm)
6” Extension Set
12” Extension Set
14Fr, Tracheostomy, DSE, Wet Pak* (size 4.6mm, length 12in/30.5cm)
14Fr, Tracheostomy, DSE, Double Lumen (size 4.6mm, length 12in/30.5cm)
14Fr, Wet Pak*, DSE (size 4.6mm, length 21.3in/54cm)
DSE, built-in MDI (size 4.6mm, length 21.3in/54cm)
Case
Case
Case
Case
Case
Case
Case
Case
Case
20
20
20
1
1
20
20
20
20
A4605
A4605
A4605
N/A
N/A
A4605
A4605
A4605
A4605
Case
Case
Case
50
50
50
N/A
N/A
N/A
Case
Case
Case
Case
Case
Case
Case
Case
20
20
20
20
20
20
20
20
A4605
A4605
A4605
A4605
A4605
A4605
A4605
A4605
Case
Case
20
20
A4605
A4605
MISCELLANEOUS
111
112
113
15mm ID x 15mm OD Swivel Adapter
15mm OD x 22mm ID Artificial Nose Adapter
Flex Tube 10cc
TURBO-CLEANING CLOSED SUCTION SYSTEM
227
2270135
22703
22705
227135
22715
22716
2271603
14Fr, DSE
14Fr, Tracheostomy, T-Piece
14Fr, Tracheostomy DSE
14Fr, T-Piece
12Fr, Tracheostomy T-Piece
T-Piece
12Fr, DSE
12Fr, Tracheostomy DSE
HALYARD* TURBO-CLEANING CLOSED SUCTION CATHETER - QWIK CLIP*
227163
2273
QWIK-CLIP* 12Fr
QWIK-CLIP* 14Fr
*Registered Trademark or Trademark of Halyard Health, Inc., or its affiliates. © 2016 HYH. All rights reserved
CATALOG
NUMBER
DESCRIPTION
UNIT OF
MEAS.
QTY/U
OM
HCPCS
HEAT MOISTURE EXCHANGERS AND FILTERS (HME)
1156
150
151
152
153
157
1157
HME
FLEX HME
500 HME
1000 HME
1500 HME
HMEF 1000
Pediatric T Tracheostomy HME
Case
Case
Case
Case
Case
Case
Case
50
50
50
50
50
50
50
A4483
A4483
A4483
A4483
A4483
A4483
A4483
Case
Case
Case
Case
Case
20
20
20
20
20
A4605
A4605
A4605
A4605
A4605
Case
Case
Case
Case
Case
Case
50
50
50
25
25
25
A4628
A4628
A4628
A4628
A4628
A4628
144
A4216
NEONATAL AND PEDIATRIC
8311
8312
8313
8314
8169
5Fr, Pediatric Elbow
6Fr
8Fr
10Fr
14Fr Tracheostomy, 15x22 ADPT
ORAL SUCTION CATHETERS
1221
1222
1223
12601
12603
12604
6 Fr Oral Suction Catheter (Neonatal/Pediatric)
8 Fr Oral Suction Catheter (Neonatal/Pediatric)
10 Fr Oral Suction Catheter (Neonatal/Pediatric)
Oral Suction Catheters
Angled Tip Suction Catheter
Oral Suction Catheters
SALINE VIALS
116
Unit Dose Saline .9%
Case
Note: Sterile water, saline covered by Medicare when used to clear a suction catheter after tracheostomy suctioning.
*Registered Trademark or Trademark of Halyard Health, Inc., or its affiliates. © 2016 HYH. All rights reserved