MEDICARE HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATION

(APC) Pass -Through List C-Code Cross-Reference Guide to Boston Scientific Products Medicare Reinstates C-Codes Effective January 1, 2004

Effective January 1, 2004, Medicare reinstated the 95 pass-through codes that were retired on 1/1/03. These C-Codes, which only apply to Medicare hospital outpatient claims, will not trigger additional payment to the outpatient hospital facility. They have been reinstated to assist Medicare in establishing future APC rates.

Below is an excerpt from the Centers for Medicare and Medicaid Services (CMS) — the federal agency that oversees the Medicare program — November 7, 2003 Outpatient Prospective Payment System (OPPS) Final Rule: “For 2004, we (CMS) are reactivating the C codes for device categories as they existed on December 31, 2002.” As of January 1, 2005, the Centers for Medicare and Medicaid Services (CMS) requires hospitals to report all device category codes (CCodes) on Medicare outpatient claims when medical devices are used in conjunction with procedure(s) billed. If C-Codes are not identified on submitted Medicare outpatient claims, the claims(s) will be returned to the hospital for correction.

BACKGROUND:

APC refers to the hospital outpatient payment system that was made effective on August 1, 2000. This system, mandated by federal law to replace the former retrospective cost-based reimbursement system, utilizes pre-set, capped payments for each APC. APCs cluster outpatient procedures into groups based on comparable resource use and clinical similarities. APCs pertain to Medicare outpatient services only and have no bearing on Medicare inpatient or physician reimbursement.

1

C-Code Cross Reference Guide and Summary

Medicare Category Codes (C-Codes)

C-Code Summary

C-Code Cross Reference Summary

C-Code C-Code Description Devices Impacted

C1726 Catheter, balloon dilation, non-vascular

CRE™ Single-Use Fixed Wire Esophageal Balloon Dilators

CRE Single-Use Pulmonary Balloon Dilators

CRE Single-Use Wireguided Esophageal/Pyloric/Biliary Balloon Dilators

CRE Single-Use Wireguided Esophageal/Pyloric/Colonic/Biliary Balloon Dilators

CRE Single-Use Wireguided Biliary Balloon Dilators

Hurricane™ RX Single-Use Biliary Dilatation Balloon Catheters

MaxForce™ Biliary Balloon Dilatation Catheters

MaxForce TTS™ Single-Use Balloon Dilators

Rigiflex™ II Single-Use Achalasia Balloon Dilators

C1769 Guide wire

All BSC guide wires used in GI procedures

Dreamtome™ RX Cannulating Sphincterotomes

Hydratome™ RX Cannulating Sphincterotomes

Jagtome™ RX Cannulating Sphincterotomes

TRUEtome™ Cannulating Sphincterotome

C1874 Stent, coated/covered, with delivery system

Polyflex™ Single-Use Esophageal Stent System

Polyflex Single-Use Self-Expanding Silicone Airway Stent System

Ultraflex™ Single-Use Covered Esophageal NG Stent System – Distal Release

Ultraflex Single-Use Covered Esophageal NG Stent System – Proximal Release

Ultraflex Single-Use Covered Large Esophageal NG Stent System – Distal Release

Ultraflex Single-Use Covered Large Esophageal NG Stent System – Proximal Release

Ultraflex Single-Use Covered Tracheobronchial Stent System - Distal Release

WallFlex™ Biliary RX Fully Covered Stent System

WallFlex Biliary RX Partially Covered Stent System

WallFlex Fully Covered Esophageal Stent

WallFlex Partially Covered Esophageal Stent System

WALLSTENT™ Endoscopic Biliary Endoprosthesis Stents

C1875 Stent, coated/covered without delivery system Dynamic™ (Y) Stent

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 2

C-Code Summary (Cont’d)

C-Code C-Code Description Devices Impacted1

C1876Stent, non-coated/non-covered, with delivery system

Ultraflex™ Precision Single-Use Colonic Stent System

Ultraflex Single-Use Uncovered Esophageal NG Stent System – Distal Release

Ultraflex Single-Use Uncovered Esophageal NG Stent System – Proximal Release

Ultraflex Single-Use Uncovered Tracheobronchial Stent System – Distal Release

Ultraflex Single-Use Uncovered Tracheobronchial Stent System – Proximal Release

WallFlex™ Single-Use Colonic Stent System

WallFlex Single-Use Duodenal Stent System

WallFlex Biliary RX Uncovered Stent System

WALLSTENT™ RX Biliary Endoprosthesis Stent System

WALLSTENT Endoscopic Biliary Endoprosthesis Stents

WALLSTENT Single-Use Colonic and Duodenal Endoprosthesis with Unistep™ Plus Delivery System

C2617Stent, non-coronary, temporary, without delivery system

Advanix™ Biliary Stent

Advanix Pancreatic Stent

C-Flex™ Double Pigtail Biliary Stent

Percuflex™ Duodenal Bend Biliary Stents

C2625Stent, non-coronary, temporary, with delivery system

Advanix Preloaded Biliary Stent Systems

Advanix Pancreatic Stent Kits

Flexima™ Biliary Stent Systems

Percuflex Duodenal Bend Biliary Stent with Introducer Kit1

RX Biliary Stents with RX Delivery System™

C1886Catheter, extravascular tissue ablation, any modality (insertable)

Alair™ Bronchial Thermoplasty Catheter

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23.

1 For devices packaged in kits, hospitals may bill for the components of the kits that individually qualify for C-Codes. Facilities should bill for the estimated proportion of the kit that the C-Code eligible device comprises

3

Achalasia Balloons

Balloon Dilators

C1726 : Catheter, balloon dilation, non-vascularDevice Name UPN Order # Description CAT Code

Rigiflex™ II Single-Use Achalasia Balloon Dilators

M00554500 5450 Rigiflex II Single Use ABD 30mm C1726

M00554510 5451 Rigiflex II Single Use ABD 35mm C1726

M00554520 5452 Rigiflex II Single Use ABD 40mm C1726

C1726 : Catheter, balloon dilation, non-vascularDevice Name UPN Order # Description CAT Code

MaxForce TTS™ Single-Use Balloon Dilators

M00589060 8906 MFTTS/6-6/180 C1726M00589080 8908 MFTTS/8-6/180 C1726M00589100 8910 MFTTS/10-6/180 C1726M00589120 8912 MFTTS/12-6/180 C1726M00589140 8914 MFTTS/14-6/180 C1726M00589150 8915 MFTTS/15-6/180 C1726M00589160 8916 MFTTS/16-6/180 C1726M00589180 8918 MFTTS/18-6/180 C1726

C1726 : Catheter, balloon dilation, non-vascularDevice Name UPN Order # Description CAT Code

CRE™ Single-Use Wireguided Esophageal / Pyloric / Colonic Balloon Dilators

M00558450 5845 CRE WG 6-8MM/240CM/5.5 F/G C1726M00558460 5846 CRE WG 8-10MM/240CM/5.5 F/G C1726M00558470 5847 CRE WG 10-12MM/240CM/5.5 F/G C1726M00558480 5848 CRE WG 12-15MM/240CM/5.5 F/G C1726M00558490 5849 CRE WG 15-18MM/240CM/5.5 F/G C1726M00558500 5850 CRE WG 18-20MM/240CM/5.5 F/G C1726

C1726 : Catheter, balloon dilation, non-vascularDevice Name UPN Order # Description CAT Code

MaxForce™ Biliary Balloon Dilatation Catheters

M00567330 6733 MaxForce/4-2/5/180 C1726M00567340 6734 MaxForce/4-4/5/180 C1726M00567370 6737 MaxForce/6-2/5/180 C1726M00567380 6738 MaxForce/6-4/5/180 C1726M00567410 6741 MaxForce/8-2/5/180 C1726M00567420 6742 MaxForce/8-3/5/180 C1726

C1726 : Catheter, balloon dilation, non-vascularDevice Name UPN Order # Description CAT Code

CRE Single-Use Fixed Wire Esophageal Balloon Dilators

M00558330 5833 CRE 6-8MM 8CM F/G C1726M00558340 5834 CRE 8-10MM 8CM F/G C1726M00558350 5835 CRE 10-12MM 8CM F/G C1726M00558360 5836 CRE 12-15MM 8CM F/G C1726M00558361 5836 CRE FIXED WIRE 5836-05 C1726M00558370 5837 CRE 15-18MM 8CM F/G C1726M00558371 5837 CRE FIXED WIRE 5837-05 C1726M00558380 5838 CRE 18-20MM 8CM F/G C1726M00558381 5838 CRE FIXED WIRE 5838-05 C1726

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 4

Balloon Dilators (Cont.)C1726 : Catheter, balloon dilation, non-vascularDevice Name UPN Order # Description CAT Code

Hurricane™ RX Single-Use Biliary Balloon Dilatation Catheters

M00545890 4589 RX DILATATION BLN 4-2/5.8/180 C1726

M00545900 4590 RX DILATATION BLN 4-4/5.8/180 C1726

M00545910 4591 RX DILATATION BLN 6-2/5.8/180 C1726

M00545920 4592 RX DILATATION BLN 6-4/5.8/180 C1726

M00545930 4593 RX DILATATION BLN 8-2/5.8/180 C1726

M00545940 4594 RX DILATATION BLN 8-4/5.8/180 C1726

M00545950 4595 RX DILATATION BLN 10-2/5.8/180 C1726

M00545960 4596 RX DILATATION BLN 10-4/5.8/180 C1726

C1726 : Catheter, balloon dilation, non-vascularDevice Name UPN Order # Description CAT Code

CRE Single-Use Wireguided Esophageal / Pyloric / Biliary Balloon Dilators

M00558600 5860 CRE WG w/Biliary 6-8MM/180CM/5.5 F/G C1726

M00558610 5861 CRE WG w/Biliary 8-10MM/180CM/5.5 F/G C1726

M00558620 5862 CRE WG w/Biliary 10-12MM/180CM/5.5 F/G C1726

M00558630 5863 CRE WG w/Biliary 12-15MM/180CM/5.5 F/G C1726

M00558640 5864 CRE WG w/Biliary 15-18MM/180CM/5.5 F/G C1726

M00558650 5865 CRE WG w/Biliary 18-20MM/180CM/5.5 F/G C1726

C1726 : Catheter, balloon dilation, non-vascularDevice Name UPN Order # Description CAT Code

CRE™ Single-Use Pulmonary Balloon Dilators

M00550300 5030 CRE PULM 5.5CM 12-15MM OD 75CM C1726

M00550310 5031 CRE PULM 5.5CM 15-18MM OD 75CM C1726

M00550320 5032 CRE PULM 5.5CM 18-20MM OD 75CM C1726

M00550330 5033 CRE PULM 3CM 8-10MM OD 75CM C1726

M00550340 5034 CRE PULM 3CM 10-12MM OD 75CM C1726

M00550350 5035 CRE PULM 3CM 12-15MM OD 75CM C1726

C1726 : Catheter, balloon dilation, non-vascularDevice Name UPN Order # Description CAT Code

CRE Single-Use Wireguided Esophageal / Pyloric / Colonic / Biliary Balloon Dilators

M00558660 5866 CRE WG w/Biliary 6-8MM/240CM/5.5 F/G C1726

M00558670 5867 CRE WG w/Biliary 8-10MM/240CM/5.5 F/G C1726

M00558680 5868 CRE WG w/Biliary 10-12MM/240CM/5.5 F/G C1726

M00558690 5869 CRE WG w/Biliary 12-15MM/240CM/5.5 F/G C1726

M00558700 5870 CRE WG w/Biliary 15-18MM/240CM/5.5 F/G C1726

M00558710 5871 CRE WG w/Biliary 18-20MM/240CM/5.5 F/G C1726

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 5

G.I. Guidewires

C1769 : GuidewireDevice Name UPN Order # Description CAT Code

Jagwire™ High Performance Guidewires

M00556461 5646 JAG HINI 025/260 ST C1769

M00556481 5648 JAG HINI 025/260 (SS) ST C1769

M00556491 5649 JAG HINI 025/260 (SS) ANG C1769

M00556561 5656 JAGWIRE/025/STRAIGHT C1769

M00556581 5658 JAGWIRE/035/STRAIGHT C1769

M00556591 5659 JAGWIRE/035/ANGLED C1769

M00556601 5660 JAGWIRE/035/STRAIGHT STIFF C1769

M00556611 5661 ENDOJAG .035 SS/450 ANG. C1769

M00556621 5662 JAGWIRE/038/260CM STRAIGHT C1769

M00556631 5663 JAGWIRE/035/260CM SS ST C1769

M00556641 5664 JAGWIRE/035/260CM STRAIGHT C1769

M00556651 5665 JAGWIRE/035/260CM ANGLED C1769

M00556661 5666 JAGWIRE/035/260CM SS ANGLED C1769

M00556841 5684 JAGWIRE 035/260 CM STRAIGHT C1769

M00556851 5685 EXTEND JAGWIRE 035/260 CM ANGLED C1769

M00556861 5686 JAGWIRE 035/260 CM SS STRAIGHT C1769

M00556871 5687 EXTEND JAGWIRE 035/260 CM SS ANGLED C1769

M00556902 5690 JAGTAIL /.035/200 CM C1769

C1769 : GuidewireDevice Name UPN Order # Description CAT Code

Dreamwire™ High Performance Guidewire

M00556101 5610 Dreamwire F/G .035"/Stnd/260cm/STR C1769

M00556111 5611 Dreamwire F/G .035"/Stnd/260cm/ANG C1769

M00556121 5612 Dreamwire F/G .035"/Stiff/260cm/STR C1769

M00556131 5613 Dreamwire F/G .035"/Stiff/260cm/ANG C1769

M00556141 5614 Dreamwire F/G .035"/Stnd/450cm/STR C1769

M00556151 5615 Dreamwire F/G .035"/Stnd/450cm/ANG C1769

M00556161 5616 Dreamwire F/G .035"/Stiff/450cm/STR C1769

M00556171 5617 Dreamwire F/G .035"/Stiff/450cm/ANG C1769

C1769 : GuidewireDevice Name UPN Order # Description CAT Code

Pulmonary Jagwire Pulmonary Guidewire

M00515171 1517 PULM JAGWIRE SS 180 cm 0.035 STRGT C1769

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 6

C1769 : GuidewireDevice Name UPN Order # Description CAT Code

Hydra Jagwire™ High Performance Guidewires

M00556001 5600 Hydra-Jag/.035/260cm/STR C1769

M00556011 5601 Hydra-Jag/.035/260cm/ANG C1769

M00556021 5602 Hydra-Jag/.035/260cm/SS/STR C1769

M00556031 5603 Hydra-Jag/.035/260cm/SS/ANG C1769

M00556041 5604 Hydra-Jag/.035/450cm/STR. C1769

M00556051 5605 Hydra-Jag/.035/450cm/ANG C1769

M00556061 5606 Hydra-Jag/.035/450cm/SS/STR C1769

M00556071 5607 Hydra-Jag/.035/450cm/SS/ANG. C1769

G.I. Guidewires (Cont.)

C1769 : GuidewireDevice Name UPN Order # Description CAT Code

Jagtome™ RX Cannulating Sphincterotome (Preloaded with Jagwire™ Guidewire)

M00573000 7300 Jagtome RX 49-20-260-035 C1769

M00573010 7301 Jagtome RX 49-20-450-035 C1769

M00573020 7302 Jagtome RX 49-30-260-035 C1769

M00573030 7303 Jagtome RX 49-30-450-035 C1769

M00573040 7304 Jagtome RX 44-20-260-035 C1769

M00573050 7305 Jagtome RX 44-20-450-035 C1769

M00573060 7306 Jagtome RX 44-30-260-035 C1769

M00573070 7307 Jagtome RX 44-30-450-035 C1769

M00573080 7308 Jagtome RX 39-20-260-025 C1769

M00573090 7309 Jagtome RX 39-20-450-025 C1769

M00573100 7310 Jagtome RX 39-30-260-025 C1769

M00573110 7311 Jagtome RX 39-30-450-025 C1769

C1769 : GuidewireDevice Name UPN Order # Description CAT Code

Pathfinder™ Exchange Guidewire – Stiff Shaft

M00551591 5159 PATHFINDER 018/450 C1769

C1769 : GuidewireDevice Name UPN Order # Description CAT Code

Amplatz Super Stiff™ Esophageal Guidewire

M00550090 5009 MVI ENDO-AMPLATZ SS 038/260 GUIDEWIRE C1769

C1769 : GuidewireDevice Name UPN Order # Description CAT Code

WALLSTENT™ Super Stiff Guidewire

H965180011 18001 GUIDEWIRE/GI .035 500CM C1769

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 7

C1769 : GuidewireDevice Name UPN Order # Description CAT Code

Hydratome™ RX Cannulating Sphincterotome (Preloaded with Hydra Jagwire™ Guidewire)

M00583000 8300 HydraTome RX 49-20mm/260cm C1769

M00583010 8301 HydraTome RX 49-30mm/260cm C1769

M00583020 8302 HydraTome RX 49-20mm/450cm C1769

M00583030 8303 HydraTome RX 49-30mm/450cm C1769

M00583040 8304 HydraTome RX 44-20mm/260cm C1769

M00583050 8305 HydraTome RX 44-30mm/260cm C1769

M00583060 8306 HydraTome RX 44-20mm/450cm C1769

M00583070 8307 HydraTome RX 44-30mm/450cm C1769

C1769 : GuidewireDevice Name UPN Order # Description CAT Code

Dreamtome™ RX Cannulating Sphincterotome (Preloaded with Dreamwire™ High Performance Guidewire)

M00584000 8400 Dreamtome 49-20mm/260cm C1769

M00584010 8401 Dreamtome 49-30mm/260cm C1769

M00584020 8402 Dreamtome 49-20mm/450cm C1769

M00584030 8403 Dreamtome 49-30mm/450cm C1769

M00584040 8404 Dreamtome 44-20mm/260cm C1769

M00584050 8405 Dreamtome 44-30mm/260cm C1769

M00584060 8406 Dreamtome 44-20mm/450cm C1769

M00584070 8407 Dreamtome 44-30mm/450cm C1769

G.I. Guidewires (Cont.)

C1769 : GuidewireDevice Name UPN Order # Description CAT Code

NaviPro™ Hydrophilic Guidewire

M00556181 5618 0.018in 260cm Angle Tip Std C1769

M00556191 5619 0.018in 260cm Angle Tip Std C1769

M00556201 5620 0.018in 260cm Angle Tip Std C1769

M00556211 5621 0.018in 260cm Angle Tip Std C1769

M00556221 5622 0.018in 260cm Angle Tip Std C1769

M00556231 5623 0.018in 260cm Angle Tip Std C1769

M00556241 5624 0.018in 260cm Angle Tip Std C1769

M00556251 5625 0.018in 260cm Angle Tip Std C1769

C1769 : GuidewireDevice Name UPN Order # Description CAT Code

TRUEtome™ Cannulating Sphincterotome Preloaded Devices

M00583080 8308 TRUEtome 39 20mm Preload Jag 024 450cm C1769

M00583090 8309 TRUEtome 44 20mm Preload Jag 025 450cm C1769

M00583100 8310 TRUEtome 44 20mm Preload Jag 035 450cm C1769

M00583110 8311 TRUEtome 44 20mm Preload Jag 035SS 450cm C1769

M00583120 8312 TRUEtome 39 30mm Preload Jag 025 450cm C1769

M00583130 8313 TRUEtome 44 30mm Preload Jag 025 450cm C1769

M00583140 8314 TRUEtome 44 30mm Preload Jag 035 450cm C1769

M00583150 8315 TRUEtome 44 30mm Preload Jag 035SS 450cm C1769

M00583160 8316 TRUEtome 44 20mm Preload Hydrawire 450cm C1769

M00583170 8317 TRUEtome 44 30mm Preload Hydrawire 450cm C1769

M00583180 8318 TRUEtome 44 20mm Preload Dreamwire 260cm C1769

M00583190 8319 TRUEtome 44 20mm Preload Dreamwire 450cm C1769

M00583200 8320 TRUEtome 44 30mm Preload Dreamwire 260cm C1769

M00583210 8321 TRUEtome 44 30mm Preload Dreamwire 450cm C1769

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 8

Plastic Biliary StentsC2625: Stent, non-coronary, temporary, with delivery systemDevice Name UPN Order # Description CAT Code

Flexima™ Single Pigtail Nasobiliary Catheter

M00540110 4011 NASAL BILIARY TUBE 5FR C2625

M00540120 4012 NASAL BILIARY TUBE 6FR C2625

M00540130 4013 NASAL BIILARY TUBE 7.5FR C2625

M00540140 4014 NASAL BILIARY TUBE 8.5FR C2625

C2625: Stent, non-coronary, temporary, with delivery systemDevice Name UPN Order # Description CAT Code

Flexima™ Duodenal Bend Biliary Stent with Delivery System

M00539200 3920 (Flexima) BILIARY STENT 7FR/5CM C2625

M00539210 3921 (Flexima) BILIARY STENT 7FR/7CM C2625

M00539220 3922 (Flexima) BILIARY STENT 7FR/10CM C2625

M00539230 3923 (Flexima) BILIARY STENT 7FR/12CM C2625

M00539240 3924 (Flexima) BILIARY STENT 7FR/15CM C2625

M00539250 3925 (Flexima) BILIARY STENT 8.5FR/5CM C2625

M00539260 3926 (Flexima) BILIARY STENT 8.5FR/7CM C2625

M00539270 3927 (Flexima) BILIARY STENT 8.5FR/10CM C2625

M00539280 3928 (Flexima) BILIARY STENT 8.5FR/12CM C2625

M00539290 3929 (Flexima) BILIARY STENT 8.5FR/15CM C2625

M00539300 3930 (Flexima) BILIARY STENT 10FR/5CM C2625

M00539310 3931 (Flexima) BILIARY STENT 10FR/7CM C2625

M00539320 3932 (Flexima) BILARY STENT 10FR/10CM C2625

M00539330 3933 (Flexima) BILIARY STENT 10FR/12CM C2625

M00539340 3934 (Flexima) BILIARY STENT 10FR/15CM C2625

M00539350 3935 (Flexima) BILIARY STENT 11.5FR/5CM C2625

M00539360 3936 (Flexima) BILIARY STENT 11.5FR/7CM C2625

M00539370 3937 (Flexima) BILIARY STENT 11.5FR/10CM C2625

M00539380 3938 (Flexima) BILIARY STENT 11.5FR/12CM C2625

M00539390 3939 (Flexima) BILIARY STENT 11.5FR/15CM C2625

C2625: Stent, non-coronary, temporary, with delivery systemDevice Name UPN Order # Description CAT Code

Percuflex™ Duodenal Bend Biliary Stent with Introducer Kits w/Push Catheter

M00533760 3376 PERC AMSTER STENT KIT 7FR/5CM C2625

M00533770 3377 PERC AMSTER STENT KIT 7FR/7CM C2625

M00533780 3378 PERC AMSTER STENT KIT 7FR/10CM C2625

M00533790 3379 PERC AMSTER STENT KIT 7FR/12CM C2625

M00533800 3380 PERC AMSTER STENT KIT 7FR/15CM C2625

M00533810 3381 PER AMSTER STENT KIT 10FR/5CM C2625

M00533820 3382 PER AMSTER STENT KIT 10FR/7CM C2625

M00533830 3383 PER AMSTER STENT KIT 10FR/10CM C2625

M00533840 3384 PER AMSTER STENT KIT 10FR/12CM C2625

M00533850 3385 PER AMSTER STENT KIT 10FR/15CM C2625

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 9

Plastic Biliary Stents (Cont.)

C2625: Stent, non-coronary, temporary, with delivery systemDevice Name UPN Order # Description CAT Code

RX Duodenal Biliary Stent with RX Delivery System™

M00545550 4555 RX STENT/7 X 5CM C2625

M00545560 4556 RX STENT/7 X 7CM C2625

M00545570 4557 RX STENT/7 X 10CM C2625

M00545580 4558 RX STENT/7 X 12CM C2625

M00545590 4559 RX STENT/7 X 15CM C2625

M00545600 4560 RX STENT/10 X 5CM C2625

M00545610 4561 RX STENT/10 X 7CM C2625

M00545620 4562 RX STENT/10 X 10CM C2625

M00545630 4563 RX STENT/10 X 12CM C2625

M00545640 4564 RX STENT/10 X 15CM C2625

M00545650 4565 RX STENT/8.5 X 5CM C2625

M00545660 4566 RX STENT/8.5 X 7CM C2625

M00545670 4567 RX STENT/8.5 X 10CM C2625

M00545680 4568 RX STENT/8.5 X 12CM C2625

M00545690 4569 RX STENT/8.5 X 15CM C2625

M00545700 4570 RX STENT/11.5 X 5CM C2625

M00545710 4571 RX STENT/11.5 X 7CM C2625

M00545720 4572 RX STENT/11.5 X 10CM C2625

M00545730 4573 RX STENT/11.5 X 12CM C2625

M00545740 4574 RX STENT/11.5 X 15CM C2625

C2625: Stent, non-coronary, temporary, with delivery systemDevice Name UPN Order # Description CAT Code

Advanix™ Duodenal Bend Preloaded RX Stent Systems

M00534200 3420 Advanix Duodenal Bend 7FR X 5CM C2625

M00534210 3421 Advanix Duodenal Bend 7FR X 7CM C2625

M00534220 3422 Advanix Duodenal Bend 7FR X 9CM C2625

M00534230 3423 Advanix Duodenal Bend 7FR X 12CM C2625

M00534240 3424 Advanix Duodenal Bend 7FR X 15CM C2625

M00534250 3425 Advanix Duodenal Bend 7FR X 18CM C2625

M00534260 3426 Advanix Duodenal Bend 8.5FR X 5CM C2625

M00534270 3427 Advanix Duodenal Bend 8.5FR X 7CM C2625

M00534280 3428 Advanix Duodenal Bend 8.5FR X 9CM C2625

M00534290 3429 Advanix Duodenal Bend 8.5FR X 12CM C2625

M00534300 3430 Advanix Duodenal Bend 8.5FR X 15CM C2625

M00534310 3431 Advanix Duodenal Bend 8.5FR X 18CM C2625

M00534320 3432 Advanix Duodenal Bend 10FR X 5CM C2625

M00534330 3433 Advanix Duodenal Bend 10FR X 7CM C2625

M00534340 3434 Advanix Duodenal Bend 10FR X 9CM C2625

M00534350 3435 Advanix Duodenal Bend 10FR X 12CM C2625

M00534360 3436 Advanix Duodenal Bend 10FR X 15CM C2625

M00534370 3437 Advanix Duodenal Bend 10FR X 18CM C2625

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 10

Plastic Biliary Stents (Cont.)C2625: Stent, non-coronary, temporary, with delivery systemDevice Name UPN Order # Description CAT Code

Advanix™ Center Bend Preloaded RX Stent Systems

M00534560 3456 Advanix Center Bend 7FR X 5CM C2625

M00534570 3457 Advanix Center Bend 7FR X 7CM C2625

M00534580 3458 Advanix Center Bend 7FR X 9CM C2625

M00534590 3459 Advanix Center Bend 7FR X 12CM C2625

M00534600 3460 Advanix Center Bend 7FR X 15CM C2625

M00534610 3461 Advanix Center Bend 7FR X 18CM C2625

M00534620 3462 Advanix Center Bend 8.5FR X 5CM C2625

M00534630 3463 Advanix Center Bend 8.5FR X 7CM C2625

M00534640 3464 Advanix Center Bend 8.5FR X 9CM C2625

M00534650 3465 Advanix Center Bend 8.5FR X 12CM C2625

M00534660 3466 Advanix Center Bend 8.5FR X 15CM C2625

M00534670 3467 Advanix Center Bend 8.5FR X 18CM C2625

M00534680 3468 Advanix Center Bend 10FR X 5CM C2625

M00534690 3469 Advanix Center Bend 10FR X 7CM C2625

M00534700 3470 Advanix Center Bend 10FR X 9CM C2625

M00534710 3471 Advanix Center Bend 10FR X 12CM C2625

M00534720 3472 Advanix Center Bend 10FR X 15CM C2625

M00534730 3473 Advanix Center Bend 10FR X 18CM C2625

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 11

C2625: Stent, non-coronary, temporary, with delivery systemDevice Name UPN Order # Description CAT Code

Advanix Pancreatic Stent Kits

M00537350 3735 PANC PIGTAIL STENT KIT 4FX3CM C2625

M00537360 3736 PANC PIGTAIL STENT KIT 4FX4CM C2625

M00537370 3737 PANC PIGTAIL STENT KIT 4FX5CM C2625

M00537380 3738 PANC PIGTAIL STENT KIT 4FX7CM C2625

M00537390 3739 PANC PIGTAIL STENT KIT 5FX3CM C2625

M00537400 3740 PANC PIGTAIL STENT KIT 5FX4CM C2625

M00537410 3741 PANC PIGTAIL STENT KIT 5FX5CM C2625

M00537420 3742 PANC PIGTAIL STENT KIT 5FX7CM C2625

M00537430 3743 PANC PIGTAIL STENT LB KIT 5FX3CM C2625

M00537440 3744 PANC PIGTAIL STENT LB KIT 5FX4CM C2625

M00537450 3745 PANC PIGTAIL STENT LB 5FX5CM C2625

M00537460 3746 PANC STRAIGHT STENT KIT 4FX3CM C2625

M00537470 3747 PANC STRAIGHT STENT KIT 4FX4CM C2625

M00537480 3748 PANC STRAIGHT STENT KIT 4FX5CM C2625

M00537500 3750 PANC STRAIGHT STENT KIT 5FX3CM C2625

M00537510 3751 PANC STRAIGHT STENT KIT 5FX4CM C2625

M00537520 3752 PANC STRAIGHT STENT KIT 5FX5CM C2625

M00537530 3753 PANC STRAIGHT STENT KIT 5FX7CM C2625

M00537540 3754 PANC STRAIGHT STENT LB KIT 5FX3CM C2625

M00537550 3755 PANC STRAIGHT STENT LB KIT 5FX4CM C2625

M00537560 3756 PANC STRAIGHT STENT LB KIT 5FX5CM C2625

Plastic Biliary Stents (Cont.)C2617: Stent, non-coronary, temporary, without delivery systemDevice Name UPN Order # Description CAT Code

Advanix™ Duodenal Bend - Single Stent

M00532870 3287 Advanix Duo Bend-Single 7FR X 5CM C2617

M00532880 3288 Advanix Duo Bend-Single 7FR X 7CM C2617

M00532890 3289 Advanix Duo Bend-Single 7FR X 9CM C2617

M00532900 3290 Advanix Duo Bend-Single 7FR X 12CM C2617

M00532910 3291 Advanix Duo Bend-Single 7FR X 15CM C2617

M00532920 3292 Advanix Duo Bend-Single 7FR X 18CM C2617

M00532930 3293 Advanix Duo Bend-Single 8.5FR X 5CM C2617

M00532940 3294 Advanix Duo Bend-Single 8.5FR X 7CM C2617

M00532950 3295 Advanix Duo Bend-Single 8.5FR X 9CM C2617

M00532960 3296 Advanix Duo Bend-Single 8.5FR X 12CM C2617

M00532970 3297 Advanix Duo Bend-Single 8.5FR X 15CM C2617

M00532980 3298 Advanix Duo Bend-Single 8.5FR X 18CM C2617

M00532990 3299 Advanix Duo Bend-Single 10FR X 5CM C2617

M00533000 3300 Advanix Duo Bend-Single 10FR X 7CM C2617

M00533010 3301 Advanix Duo Bend-Single 10FR X 9CM C2617

M00533020 3302 Advanix Duo Bend-Single 10FR X 12CM C2617

M00533030 3303 Advanix Duo Bend-Single 10FR X 15CM C2617

M00533040 3304 Advanix Duo Bend-Single 10FR X 18CM C2617

C2617: Stent, non-coronary, temporary, without delivery systemDevice Name UPN Order # Description CAT Code

Advanix Center Bend - Single Stent

M00533230 3323 Advanix Ctr Bend-Single  7FR X 5CM C2617

M00533240 3324 Advanix Ctr Bend-Single  7FR X 7CM C2617

M00533250 3325 Advanix Ctr Bend-Single  7FR X 9CM C2617

M00533260 3326 Advanix Ctr Bend-Single  7FR X 12CM C2617

M00533270 3327 Advanix Ctr Bend-Single  7FR X 15CM C2617

M00533280 3328 Advanix Ctr Bend-Single  7FR X 18CM C2617

M00533290 3329 Advanix Ctr Bend-Single  8.5FR X 5CM C2617

M00533300 3330 Advanix Ctr Bend-Single  8.5FR X 7CM C2617

M00533310 3331 Advanix Ctr Bend-Single  8.5FR X 9CM C2617

M00533320 3332 Advanix Ctr Bend-Single  8.5FR X 12CM C2617

M00533330 3333 Advanix Ctr Bend-Single  8.5FR X 15CM C2617

M00533340 3334 Advanix Ctr Bend-Single  8.5FR X 18CM C2617

M00533350 3335 Advanix Ctr Bend-Single  10FR X 5CM C2617

M00533360 3336 Advanix Ctr Bend-Single  10FR X 7CM C2617

M00533370 3337 Advanix Ctr Bend-Single  10FR X 9CM C2617

M00533380 3338 Advanix Ctr Bend-Single  10FR X 12CM C2617

M00533390 3339 Advanix Ctr Bend-Single  10FR X 15CM C2617

M00533400 3340 Advanix Ctr Bend-Single  10FR X 18CM C2617

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 12

Plastic Biliary Stents (Cont.)C2617: Stent, non-coronary, temporary, without delivery systemDevice Name UPN Order # Description CAT Code

Advanix™ Double Pigtail - Single Stent

M00532160 3216 Advanix Double Pigtail-Single 7FR X 3CM C2617

M00532180 3218 Advanix Double Pigtail-Single 7FR X 5CM C2617

M00532190 3219 Advanix Double Pigtail-Single 7FR X 7CM C2617

M00532210 3221 Advanix Double Pigtail-Single 7FR X 10CM C2617

M00532220 3222 Advanix Double Pigtail-Single 7FR X 12CM C2617

M00532230 3223 Advanix Double Pigtail-Single 7FR X 15CM C2617

M00532240 3224 Advanix Double Pigtail-Single 10FR X 3CM C2617

M00532260 3226 Advanix Double Pigtail-Single 10FR X 5CM C2617

M00532270 3227 Advanix Double Pigtail-Single 10FR X 7CM C2617

M00532290 3229 Advanix Double Pigtail-Single 10FR X 9CM C2617

M00532300 3230 Advanix Double Pigtail-Single 10FR X 12CM C2617

M00532310 3231 Advanix Double Pigtail-Single 10FR X 15CM C2617

C2617: Stent, non-coronary, temporary, without delivery systemDevice Name UPN Order # Description CAT Code

Percuflex™ Duodenal Bend Biliary Stent

M00533610 3361 PERC BIL DRAIN STENTS 7FR/5CM C2617

M00533620 3362 PERC BIL DRAIN STENTS 7FR/7CM C2617

M00533630 3363 PERC BIL DRAIN STENTS 7FR/10CM C2617

M00533640 3364 PERC BIL DRAIN STENTS 7FR/12CM C2617

M00533650 3365 PERC BIL DRAIN STENTS 7FR/15CM C2617

M00533660 3366 PERC BIL DRAIN STENT 10FR/5CM C2617

M00533670 3367 PERC BIL DRAIN STENT 10FR/7CM C2617

M00533680 3368 PERC BIL DRAIN STENT 10FR/10CM C2617

M00533690 3369 PERC BIL DRAIN STENT 10FR/12CM C2617

M00533700 3370 PERC BIL DRAIN STENT 10FR/15CM C2617

C2617: Stent, non-coronary, temporary, without delivery systemDevice Name UPN Order # Description CAT Code

C-Flex™ Double Pigtail Biliary Stent

M00532010 3201 PIGTAIL STENT 7/5 C2617

M00532020 3202 PIGTAIL STENT 7/10 C2617

M00532030 3203 PIGTAIL STENT 7/15 C2617

M00532040 3204 PIGTAIL STENT 10/5 C2617

M00532050 3205 PIGTAIL STENT 10/10 C2617

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 13

Plastic Biliary Stents (Cont.)

C2617: Stent, non-coronary, temporary, without delivery systemDevice Name UPN Order # Description CAT Code

Advanix™ Pancreatic Stent

M00536000 3600 ADVANIX PANC STENT STRT 3FRX2CM C2617

M00536010 3601 ADVANIX PANC STENT STRT 3FRX3CM C2617

M00536020 3602 ADVANIX PANC STENT STRT 3FRX4CM C2617

M00536030 3603 ADVANIX PANC STENT STRT 3FRX5CM C2617

M00536040 3604 ADVANIX PANC STENT STRT 3FRX6CM C2617

M00536050 3605 ADVANIX PANC STENT STRT 3FRX7CM C2617

M00536060 3606 ADVANIX PANC STENT STRT 3FRX8CM C2617

M00536070 3607 ADVANIX PANC STENT STRT 3FRX9CM C2617

M00536080 3608 ADVANIX PANC STENT STRT 3FRX10CM C2617

M00536090 3609 ADVANIX PANC STENT STRT 3FRX11CM C2617

M00536100 3610 ADVANIX PANC STENT STRT 3FRX12CM C2617

M00536110 3611 ADVANIX PANC STENT STRT 3FRX13CM C2617

M00536120 3612 ADVANIX PANC STENT STRT 4FRX2CM C2617

M00536130 3613 ADVANIX PANC STENT STRT 4FRX3CM C2617

M00536140 3614 ADVANIX PANC STENT STRT 4FRX4CM C2617

M00536150 3615 ADVANIX PANC STENT STRT 4FRX5CM C2617

M00536160 3616 ADVANIX PANC STENT STRT 4FRX6CM C2617

M00536170 3617 ADVANIX PANC STENT STRT 4FRX7CM C2617

M00536180 3618 ADVANIX PANC STENT STRT 4FRX8CM C2617

M00536190 3619 ADVANIX PANC STENT STRT 4FRX9CM C2617

M00536200 3620 ADVANIX PANC STENT STRT 4FRX10CM C2617

M00536210 3621 ADVANIX PANC STENT STRT 4FRX11CM C2617

M00536220 3622 ADVANIX PANC STENT STRT 4FRX12CM C2617

M00536230 3623 ADVANIX PANC STENT STRT 4FRX13CM C2617

M00536240 3624 ADVANIX PANC STENT STRT 5FRX2CM C2617

M00536250 3625 ADVANIX PANC STENT STRT 5FRX3CM C2617

M00536260 3626 ADVANIX PANC STENT STRT 5FRX4CM C2617

M00536270 3627 ADVANIX PANC STENT STRT 5FRX5CM C2617

M00536280 3628 ADVANIX PANC STENT STRT 5FRX6CM C2617

M00536290 3629 ADVANIX PANC STENT STRT 5FRX7CM C2617

M00536300 3630 ADVANIX PANC STENT STRT 5FRX8CM C2617

M00536310 3631 ADVANIX PANC STENT STRT 5FRX9CM C2617

M00536320 3632 ADVANIX PANC STENT STRT 5FRX10CM C2617

M00536330 3633 ADVANIX PANC STENT STRT 5FRX11CM C2617

M00536340 3634 ADVANIX PANC STENT STRT 5FRX12CM C2617

M00536350 3635 ADVANIX PANC STENT STRT 5FRX13CM C2617

M00536360 3636 ADVANIX PANC STENT STRT LB 5FRX2CM C2617

M00536370 3637 ADVANIX PANC STENT STRT LB 5FRX3CM C2617

M00536380 3638 ADVANIX PANC STENT STRT LB 5FRX4CM C2617

M00536390 3639 ADVANIX PANC STENT STRT LB 5FRX5CM C2617

M00536400 3640 ADVANIX PANC STENT STRT LB 5FRX6CM C2617

M00536410 3641 ADVANIX PANC STENT STRT LB 5FRX7CM C2617

M00536420 3642 ADVANIX PANC STENT STRT LB 5FRX8CM C2617

M00536430 3643 ADVANIX PANC STENT STRT LB 5FRX9CM C2617

M00536440 3644 ADVANIX PANC STENT STRT LB 5FRX10CM C2617

M00536450 3645 ADVANIX PANC STENT STRT LB 5FRX11CM C2617

M00536460 3646 ADVANIX PANC STENT STRT LB 5FRX12CM C2617

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 14

Plastic Biliary Stents (Cont.)C2617: Stent, non-coronary, temporary, without delivery systemDevice Name UPN Order # Description CAT Code

Advanix™ Pancreatic Stent

M00536470 3647 ADVANIX PANC STENT STRT LB 5FRX13CM C2617

M00536480 3648 ADVANIX PANC STENT STRT LB 7FRX3CM C2617

M00536490 3649 ADVANIX PANC STENT STRT LB 7FRX4CM C2617

M00536500 3650 ADVANIX PANC STENT STRT LB 7FRX5CM C2617

M00536510 3651 ADVANIX PANC STENT STRT LB 7FRX6CM C2617

M00536520 3652 ADVANIX PANC STENT STRT LB 7FRX7CM C2617

M00536530 3653 ADVANIX PANC STENT STRT LB 7FRX8CM C2617

M00536540 3654 ADVANIX PANC STENT STRT LB 7FRX9CM C2617

M00536550 3655 ADVANIX PANC STENT STRT LB 7FRX10CM C2617

M00536560 3656 ADVANIX PANC STENT STRT LB 7FRX11CM C2617

M00536570 3657 ADVANIX PANC STENT STRT LB 7FRX12CM C2617

M00536580 3658 ADVANIX PANC STENT STRT LB 7FRX13CM C2617

M00536590 3659 ADVANIX PANC STENT STRT LB 7FRX15CM C2617

M00536600 3660 ADVANIX PANC STENT STRT LB 7FRX18CM C2617

M00536610 3661 ADVANIX PANC STENT STRT LB 10FRX3CM C2617

M00536620 3662 ADVANIX PANC STENT STRT LB 10FRX4CM C2617

M00536630 3663 ADVANIX PANC STENT STRT LB 10FRX5CM C2617

M00536640 3664 ADVANIX PANC STENT STRT LB 10FRX6CM C2617

M00536650 3665 ADVANIX PANC STENT STRT LB 10FRX7CM C2617

M00536660 3666 ADVANIX PANC STENT STRT LB 10FRX8CM C2617

M00536670 3667 ADVANIX PANC STENT STRT LB 10FRX9CM C2617

M00536680 3668 ADVANIX PANC STENT STRT LB 10FRX10CM C2617

M00536690 3669 ADVANIX PANC STENT STRT LB 10FRX11CM C2617

M00536700 3670 ADVANIX PANC STENT STRT LB 10FRX12CM C2617

M00536710 3671 ADVANIX PANC STENT STRT LB 10FRX13CM C2617

M00536720 3672 ADVANIX PANC STENT STRT LB 10FRX15CM C2617

M00536730 3673 ADVANIX PANC STENT STRT LB 10FRX18CM C2617

M00536740 3674 ADVANIX PANC STENT PIGTAIL 3FRX2CM C2617

M00536750 3675 ADVANIX PANC STENT PIGTAIL 3FRX3CM C2617

M00536760 3676 ADVANIX PANC STENT PIGTAIL 3FRX4CM C2617

M00536770 3677 ADVANIX PANC STENT PIGTAIL 3FRX5CM C2617

M00536780 3678 ADVANIX PANC STENT PIGTAIL 3FRX6CM C2617

M00536790 3679 ADVANIX PANC STENT PIGTAIL 3FRX7CM C2617

M00536800 3680 ADVANIX PANC STENT PIGTAIL 3FRX8CM C2617

M00536810 3681 ADVANIX PANC STENT PIGTAIL 3FRX9CM C2617

M00536820 3682 ADVANIX PANC STENT PIGTAIL 3FRX10CM C2617

M00536830 3683 ADVANIX PANC STENT PIGTAIL 3FRX11CM C2617

M00536840 3684 ADVANIX PANC STENT PIGTAIL 3FRX12CM C2617

M00536850 3685 ADVANIX PANC STENT PIGTAIL 3FRX13CM C2617

M00536860 3686 ADVANIX PANC STENT PIGTAIL 4FRX2CM C2617

M00536870 3687 ADVANIX PANC STENT PIGTAIL 4FRX3CM C2617

M00536880 3688 ADVANIX PANC STENT PIGTAIL 4FRX4CM C2617

M00536890 3689 ADVANIX PANC STENT PIGTAIL 4FRX5CM C2617

M00536900 3690 ADVANIX PANC STENT PIGTAIL 4FRX6CM C2617

M00536910 3691 ADVANIX PANC STENT PIGTAIL 4FRX7CM C2617

M00536920 3692 ADVANIX PANC STENT PIGTAIL 4FRX8CM C2617

M00536930 3693 ADVANIX PANC STENT PIGTAIL 4FRX9CM C2617

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 15

Plastic Biliary Stents (Cont.)C2617: Stent, non-coronary, temporary, without delivery systemDevice Name UPN Order # Description CAT Code

Advanix™ Pancreatic Stent

M00536940 3694 ADVANIX PANC STENT PIGTAIL 4FRX10CM C2617

M00536950 3695 ADVANIX PANC STENT PIGTAIL 4FRX11CM C2617

M00536960 3696 ADVANIX PANC STENT PIGTAIL 4FRX12CM C2617

M00536970 3697 ADVANIX PANC STENT PIGTAIL 4FRX13CM C2617

M00536980 3698 ADVANIX PANC STENT PIGTAIL 5FRX2CM C2617

M00536990 3699 ADVANIX PANC STENT PIGTAIL 5FRX3CM C2617

M00537000 3700 ADVANIX PANC STENT PIGTAIL 5FRX4CM C2617

M00537010 3701 ADVANIX PANC STENT PIGTAIL 5FRX5CM C2617

M00537020 3702 ADVANIX PANC STENT PIGTAIL 5FRX6CM C2617

M00537030 3703 ADVANIX PANC STENT PIGTAIL 5FRX7CM C2617

M00537040 3704 ADVANIX PANC STENT PIGTAIL 5FRX8CM C2617

M00537050 3705 ADVANIX PANC STENT PIGTAIL 5FRX9CM C2617

M00537060 3706 ADVANIX PANC STENT PIGTAIL 5FRX10CM C2617

M00537070 3707 ADVANIX PANC STENT PIGTAIL 5FRX11CM C2617

M00537080 3708 ADVANIX PANC STENT PIGTAIL 5FRX12CM C2617

M00537090 3709 ADVANIX PANC STENT PIGTAIL 5FRX13CM C2617

M00537100 3710 ADVANIX PANC STENT PIGTAIL LB 5FRX2CM C2617

M00537110 3711 ADVANIX PANC STENT PIGTAIL LB 5FRX3CM C2617

M00537120 3712 ADVANIX PANC STENT PIGTAIL LB 5FRX4CM C2617

M00537130 3713 ADVANIX PANC STENT PIGTAIL LB 5FRX5CM C2617

M00537140 3714 ADVANIX PANC STENT PIGTAIL LB 5FRX6CM C2617

M00537150 3715 ADVANIX PANC STENT PIGTAIL LB 5FRX7CM C2617

M00537160 3716 ADVANIX PANC STENT PIGTAIL LB 5FRX8CM C2617

M00537170 3717 ADVANIX PANC STENT PIGTAIL LB 5FRX9CM C2617

M00537180 3718 ADVANIX PANC STENT PIGTAIL LB 5FRX10CM C2617

M00537190 3719 ADVANIX PANC STENT PIGTAIL LB 5FRX11CM C2617

M00537200 3720 ADVANIX PANC STENT PIGTAIL LB 5FRX12CM C2617

M00537210 3721 ADVANIX PANC STENT PIGTAIL LB 5FRX13CM C2617

M00537220 3722 ADVANIX PANC STENT PIGTAIL LB 7FRX3CM C2617

M00537230 3723 ADVANIX PANC STENT PIGTAIL LB 7FRX4CM C2617

M00537240 3724 ADVANIX PANC STENT PIGTAIL LB 7FRX5CM C2617

M00537250 3725 ADVANIX PANC STENT PIGTAIL LB 7FRX6CM C2617

M00537260 3726 ADVANIX PANC STENT PIGTAIL LB 7FRX7CM C2617

M00537270 3727 ADVANIX PANC STENT PIGTAIL LB 7FRX8CM C2617

M00537280 3728 ADVANIX PANC STENT PIGTAIL LB 7FRX9CM C2617

M00537290 3729 ADVANIX PANC STENT PIGTAIL LB 7FRX10CM C2617

M00537300 3730 ADVANIX PANC STENT PIGTAIL LB 7FRX11CM C2617

M00537310 3731 ADVANIX PANC STENT PIGTAIL LB 7FRX12CM C2617

M00537320 3732 ADVANIX PANC STENT PIGTAIL LB 7FRX13CM C2617

M00537330 3733 ADVANIX PANC STENT PIGTAIL LB 7FRX15CM C2617

M00537340 3734 ADVANIX PANC STENT PIGTAIL LB 7FRX18CM C2617

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 16

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 17

Biliary Bare Metal StentsC1876: Stent, non-coated/non-covered, with delivery systemDevice Name UPN Order # Description CAT Code

WALLSTENT™ Endoscopic Biliary Endoprosthesis Stents

H965430100 43010 8X40 BLRY ENDO UNI PLUS HALO 7.5F/219CM C1876

H965430200 43020 8X60 BLRY ENDO UNI PLUS HAL0 7.5F/219CM C1876

H965430300 43030 8X80 BLRY ENDO UNI PLUS HALO 7.5F/219CM C1876

H965430400 43040 10X40 BLRY ENDO UNI PLUS HALO7.5F/219CM C1876

H965430500 43050 10X60 BLRY ENDO UNI PLUS HALO7.5F/219CM C1876

H965430600 43060 10X80 BLRY ENDO UNI PLUS HALO7.5F/219CM C1876

C1876: Stent, non-coated/non-covered, with delivery systemDevice Name UPN Order # Description CAT Code

WALLSTENT RX Biliary Endoprosthesis Stent System

M00569610 6961 MODEL-RX WS BILIARY 8 X 40 C1876

M00569620 6962 MODEL-RX WS BILIARY 8 X 60 C1876

M00569630 6963 MODEL-RX WS BILIARY 8 X 80 C1876

M00569640 6964 MODEL-RX WS BILIARY 10 X 40 C1876

M00569650 6965 MODEL-RX WS BILIARY 10 X 60 C1876

M00569660 6966 MODEL-RX WS BILIARY 10 X 80 C1876

M00569800 6980 RX WALLSTENT BILIARY 8 X 100 C1876

M00569810 6981 RX WALLSTENT BILIARY 10 X 100 C1876

C1876: Stent, non-coated/non-covered, with delivery systemDevice Name UPN Order # Description CAT Code

WallFlex™ Biliary RX Uncovered Stent System

M00570600 7060 WALLFLEX BILIARY RX UNCOVERED 8X40 C1876

M00570610 7061 WALLFLEX BILIARY RX UNCOVERED 8X60 C1876

M00570620 7062 WALLFLEX BILIARY RX UNCOVERED 8X80 C1876

M00570630 7063 WALLFLEX BILIARY RX UNCOVERED 8X100 C1876

M00570640 7064 WALLFLEX BILIARY RX UNCOVERED 10X60 C1876

M00570650 7065 WALLFLEX BILIARY RX UNCOVERED 10X80 C1876

M00570660 7066 WALLFLEX BILIARY RX UNCOVERED 10X100 C1876

M00570890 7089 WALLFLEX BILIARY RX UNCOVERED 10x40 C1876

Biliary Covered Metal Stents

C1874: Stent, coated/covered, with delivery systemDevice Name UPN Order # Description CAT Code

WALLSTENT™ RX Biliary Endoprosthesis with Permalume™ Covering

M00569670 6967 MODEL-RX WS PERMALUME 8 X 40 C1874

M00569680 6968 MODEL-RX WS PERMALUME 8 X 60 C1874

M00569690 6969 MODEL-RX WL PERMALUME 8 X 80 C1874

M00569700 6970 MODEL-RX WS PERMALUME 10 X 40 C1874

M00569710 6971 MODEL-RX WS PERMALUME 10 X 60 C1874

M00569720 6972 MODEL-RX WS PERMALUME 10 X 80 C1874

C1874: Stent, coated/covered, with delivery systemDevice Name UPN Order # Description CAT Code

WALLSTENT Endoscopic Biliary Endoprosthesis Stents with Permalume Covering

H965430700 43070 MODEL CVD ENDO BIL 8FR 8X40 194CM C1874

H965430800 43080 MODEL CVD BIL ENDO/8FR 8X60 194CM C1874

H965430900 43090 MODEL CVD BIL ENDO 8FR 8X80 194CM C1874

H965431000 43100 MODEL CVD BIL ENDO 8FR 10X40 194CM C1874

H965431100 43110 MODEL CVD BIL ENDO 8FR 10X60 194CM C1874

H965431200 43120 MODEL CVD BIL ENDO 8FR 10X80 194CM C1874

C1874: Stent, coated/covered, with delivery systemDevice Name UPN Order # Description CAT Code

WallFlex™ Biliary RX Fully Covered Stent System

M00570500 7050 WALLFLEX BILIARY RX COVERED 8X60 C1874

M00570510 7051 WALLFLEX BILIARY RX COVERED 8X80 C1874

M00570520 7052 WALLFLEX BILIARY RX COVERED 10X40 C1874

M00570530 7053 WALLFLEX BILIARY RX COVERED 10X60 C1874

M00570540 7054 WALLFLEX BILIARY RX COVERED 10X80 C1874

C1874: Stent, coated/covered, with delivery systemDevice Name UPN Order # Description CAT Code

WallFlex Biliary RX Partially Covered Stent System

M00570700 7070 WALLFLEX BILIARY RX PARTCOVERED 8x60 C1874

M00570710 7071 WALLFLEX BILIARY RX PARTCOVERED 8x80 C1874

M00570720 7072 WALLFLEX BILIARY RX PARTCOVERED 10x40 C1874

M00570730 7073 WALLFLEX BILIARY RX PARTCOVERED 10x60 C1874

M00570740 7074 WALLFLEX BILIARY RX PARTCOVERED 10x80 C1874

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 18

Esophageal Covered StentsC1874: Stent, coated/covered, with delivery systemDevice Name UPN Order # Description CAT Code

Ultraflex™ Single-Use Covered Esophageal NG Stent System

M00513730 1373 ULTRAFLEX ESOPH NG DISTL CVD STN 18X10 C1874

M00513740 1374 ULTRAFLEX ESOPH NG DISTL CVD STN 18X12 C1874

M00513750 1375 ULTRAFLEX ESOPH NG DISTL CVD STN 18X15 C1874

M00513840 1384 ULTRAFLEX ESOPH NG PROX CVD STN 18X10 C1874

M00513850 1385 ULTRAFLEX ESOPH NG PROX CVD STN 18X12 C1874

M00513860 1386 ULTRAFLEX ESOPH NG PROX CVD STN 18X15 C1874

M00514200 1420 ULTRAFLEX ESOPH NG DST CVD STN 23X10 C1874

M00514210 1421 ULTRAFLEX ESOPH NG DST CVD STN 23X12 C1874

M00514240 1424 ULTRAFLEX ESOPH NG PROX CVD STN 23X10 C1874

M00514250 1425 ULTRAFLEX ESOPH NG PROX CVD STN 23X12 C1874

C1874: Stent, coated/covered, with delivery systemDevice Name UPN Order # Description CAT Code

Polyflex™ Single-Use Esophageal Stent System

M00514270 1427 POLYFLEX ESOPH 20/16MM X 90MM C1874

M00514280 1428 POLYFLEX ESOPH 20/16MM X 120MM C1874

M00514290 1429 POLYFLEX ESOPH 20/16MM X 150MM C1874

M00514300 1430 POLYFLEX ESOPH 23/18MM X 90MM C1874

M00514310 1431 POLYFLEX ESOPH 23/18MM X 120MM C1874

M00514320 1432 POLYFLEX ESOPH 23/18MM X 150MM C1874

M00514330 1433 POLYFLEX ESOPH 25/21MM X 90MM C1874

M00514340 1434 POLYFLEX ESOPH 25/21MM X 120MM C1874

M00514350 1435 POLYFLEX ESOPH 25/21MM X 150MM C1874

C1874: Stent, coated/covered, with delivery systemDevice Name UPN Order # Description CAT Code

WallFlex™ Fully Covered Esophageal Stent System

M00516700 1670WALLFLEX FULLY COVERED ESOPHAGEAL STENT SYSTEM 18X10

C1874

M00516710 1671WALLFLEX FULLY COVERED ESOPHAGEAL STENT SYSTEM 18X12

C1874

M00516720 1672WALLFLEX FULLY COVERED ESOPHAGEAL STENT SYSTEM 18X15

C1874

M00516730 1673WALLFLEX FULLY COVERED ESOPHAGEAL STENT SYSTEM 23X10

C1874

M00516740 1674WALLFLEX FULLY COVERED ESOPHAGEAL STENT SYSTEM 23X12

C1874

M00516750 1675WALLFLEX FULLY COVERED ESOPHAGEAL STENT SYSTEM 23X15

C1874

C1874: Stent, coated/covered, with delivery systemDevice Name UPN Order # Description CAT Code

WallFlex Partially Covered Esophageal Stent System

M00516900 1690 WALLFLEX PC ESOPH STENT 18/23mm x 103mm C1874

M00516910 1691 WALLFLEX PC ESOPH STENT 18/23mm x 123mm C1874

M00516920 1692 WALLFLEX PC ESOPH STENT 18/23mm x 153mm C1874

M00516930 1693 WALLFLEX PC ESOPH STENT 23/28mm x 105mm C1874

M00516940 1694 WALLFLEX PC ESOPH STENT 23/28mm x 125mm C1874

M00516950 1695 WALLFLEX PC ESOPH STENT 23/28mm x 155mm C1874

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 19

Esophageal Bare Metal Stents

Colonic and Duodenal Bare Metal Stents

C1876: Stent, non-coated/non-covered, with delivery systemDevice Name UPN Order # Description CAT Code

Ultraflex™ Single-Use Uncovered Esophageal NG Stent System

M00513700 1370 ULTRAFLEX ESOPH NG DISTL UNCVD STN 18X7 C1876

M00513710 1371 ULTRAFLEX ESOPH NG DISTL UNCVD STN 18X10 C1876

M00513720 1372 ULTRAFLEX ESOPH NG DISTL UNCVD STN 18X15 C1876

M00513800 1380 ULTRAFLEX ESOPH NG PROX UNCVD STN 18X7 C1876

M00513810 1381 ULTRAFLEX ESOPH NG PROX UNCVD STN 18X10 C1876

M00513830 1383 ULTRAFLEX ESOPH NG PROX UNCVD STN 18X15 C1876

C1876: Stent, non-coated/non-covered, with delivery systemDevice Name UPN Order # Description CAT Code

WALLSTENT™ Single-Use Colonic and Duodenal Endoprosthesis with UniStep™ Plus Delivery System

M00565560 6556 MODEL-ENTERAL NG 10FR 20x60/230CM C1876

M00565570 6557 MODEL-ENTERAL NG 10FR 20x90/230CM C1876

M00565580 6558 MODEL-ENTERAL NG 10FR 22x60/230CM C1876

M00565590 6559 MODEL-ENTERAL NG 10FR 22x90/230CM C1876

M00565620 6562 MODEL-ENTERAL NG 10FR 20x60/135CM C1876

M00565630 6563 MODEL-ENTERAL NG 10FR 20x90/135CM C1876

M00565640 6564 MODEL-ENTERAL NG 10FR 22x60/135CM C1876

M00565650 6565 MODEL-ENTERAL NG 10FR 22x90/135CM C1876

C1876: Stent, non-coated/non-covered, with delivery systemDevice Name UPN Order # Description CAT Code

Ultraflex Precision Single-Use Colonic Stent System

M00557330 5733 1M COLONIC 25/30X6 UNCOV PROX C1876

M00557360 5736 1M COLONIC 25/30X9 UNCOV PROX C1876

M00557380 5738 1M COLONIC 25/30X12 UNCOV PROX C1876

C1876: Stent, non-coated/non-covered, with delivery systemDevice Name UPN Order # Description CAT Code

WallFlex™ Single-Use Duodenal Stent System

M00565010 6501 WALLFLEX ENTERAL DUODENAL 27/22X 6 230CM C1876

M00565020 6502 WALLFLEX ENTERAL DUODENAL 27/22X 9 230CM C1876

M00565030 6503 WALLFLEX ENTERAL DUODENAL 27/22X 12 230CM C1876

C1876: Stent, non-coated/non-covered, with delivery systemDevice Name UPN Order # Description CAT Code

WallFlex Single-Use Colonic Stent System

M00565040 6504 WALLFLEX ENTERAL COLONIC 30/25 X 6 230CM C1876

M00565050 6505 WALLFLEX ENTERAL COLONIC 30/25 X 96 230CM C1876

M00565060 6506 WALLFLEX ENTERAL COLONIC 30/25 X 12 230CM C1876

M00565070 6507 WALLFLEX ENTERAL COLONIC 30/25 X 6 135CM C1876

M00565080 6508 WALLFLEX ENTERAL COLONIC 30/25 X 96 135CM C1876

M00565090 6509 WALLFLEX ENTERAL COLONIC 30/25 X 12 135CM C1876

M00565100 6510 WALLFLEX ENTERAL COLONIC 27/22 X 6 230CM C1876

M00565110 6511 WALLFLEX ENTERAL COLONIC 27/22 X 96 230CM C1876

M00565120 6512 WALLFLEX ENTERAL COLONIC 27/22 X 12 230CM C1876

M00565130 6513 WALLFLEX ENTERAL COLONIC 27/22 X 6 135CM C1876

M00565140 6514 WALLFLEX ENTERAL COLONIC 27/22 X 96 135CM C1876

M00565150 6515 WALLFLEX ENTERAL COLONIC 27/22 X 12 135CM C1876

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 20

Pulmonary Bare Stents

Pulmonary Covered Stents

C1876: Stent, non-coated/non-covered, with delivery systemDevice Name UPN Order # Description CAT Code

Ultraflex™ Single-Use Uncovered Tracheobronchial Stent System – Distal Release

M00576300 7630 UP/10-3/16/95 UNCOVERED DISTAL STERILE C1876

M00576310 7631 UP/12-3/16/95 UNCOVERED DISTAL STERILE C1876

M00576320 7632 UP/14-3/16/95 UNCOVERED DISTAL STERILE C1876

M00576330 7633 UP/16-4/16/95 UNCOVERED DISTAL STERILE C1876

M00576340 7634 UP/16-6/16/95 UNCOVERED DISTAL STERILE C1876

M00576350 7635 UP/18-4/16/95 UNCOVERED DISTAL STERILE C1876

M00576360 7636 UP/18-6/16/95 UNCOVERED DISTAL STERILE C1876

M00576370 7637 UP/20-4/16/95 UNCOVERED DISTAL STERILE C1876

M00576380 7638 UP/20-6/16/95 UNCOVERED DISTAL STERILE C1876

C1874: Stent, coated/covered, with delivery systemDevice Name UPN Order # Description CAT Code

Ultraflex Single-Use Covered Tracheobronchial Stent System - Distal Release

M00576520 7652 UPC/8-4/16/95,2.5CM CVER DISTAL-STERILE C1874

M00576530 7653 UPC/10-3/16/95,1.5CM CVER DISTAL-STERILE C1874

M00576540 7654 UPC/10-4/16/95,2.5CM CVER DISTAL-STERILE C1874

M00576550 7655 UPC/12-3/16/95,1.5CM CVER DISTAL-STERILE C1874

M00576560 7656 UPC/12-4/16/95,2.5CM CVER DISTAL-STERILE C1874

M00576570 7657 UPC/14-3/16/95,1.5CM CVER DISTAL-STERILE C1874

M00576580 7658 UPC/14-4/16/95,2.5CM CVER DISTAL-STERILE C1874

M00576590 7659 UPC/14-6/16/95,4.5CM CVER DISTAL-STERILE C1874

M00576600 7660 UPC/14-8/16/95,6.5CM CVER DISTAL-STERILE C1874

M00576610 7661 UPC/16-4/16/95,2.5CM CVER DISTAL-STERILE C1874

M00576620 7662 UPC/16-6/16/95,4.5CM CVER DISTAL-STERILE C1874

M00576630 7663 UPC/16-8/16/95,6.5CM CVER DISTAL-STERILE C1874

M00576640 7664 UPC/18-4/16/95,2.5CM CVER DISTAL-STERILE C1874

M00576650 7665 UPC/18-6/16/95,4.5CM CVER DISTAL-STERILE C1874

M00576660 7666 UPC/18-8/16/95,6.5CM CVER DISTAL-STERILE C1874

M00576670 7667 UPC/20-4/16/95,2.5CM CVER DISTAL-STERILE C1874

M00576680 7668 UPC/20-6/16/95,4.5CM CVER DISTAL-STERILE C1874

M00576690 7669 UPC/20-8/16/95,6.5CM CVER DISTAL-STERILE C1874

C1876: Stent, non-coated/non-covered, with delivery systemDevice Name UPN Order # Description CAT Code

Ultraflex Single-Use Uncovered Tracheobronchial Stent System – Proximal Release

M00576410 7641 UP/8-2/16/95 UNCOVERED PROX STERILE C1876

M00576420 7642 UP/8-4/16/95 UNCOVERED PROX STERILE C1876

M00576430 7643 UP/10-2/16/95 UNCOVERED PROX STERILE C1876

M00576440 7644 UP/10-4/16/95 UNCOVERED PROX STERILE C1876

M00576450 7645 UP/12-2/16/95 UNCOVERED PROX STERILE C1876

M00576460 7646 UP/12-4/16/95 UNCOVERED PROX STERILE C1876

M00576470 7647 UP/14-2/16/95 UNCOVERED PROX STERILE C1876

M00576480 7648 UP/14-4/16/95 UNCOVERED PROX STERILE C1876

M00576490 7649 UP/14-6/16/95 UNCOVERED PROX STERILE C1876

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 21

Pulmonary Covered Stents (Cont.)

ENDO-47411-AD DEC2014See important notes on the uses and limitations of this information on page 23. 22

C1874: Stent, coated/covered, with delivery system Device Name UPN Order # Description CAT Code

Polyflex™ Single-Use Self-Expanding Silicone Airway Stent System

M00570000 7000 POLYFLEX AIRWAY 8MM IDX20MM OD 7MM C1874

M00570010 7001 POLYFLEX AIRWAY 8MM IDX30MM OD 7MM C1874

M00570020 7002 POLYFLEX AIRWAY 10MM IDX20MM OD 8MM C1874

M00570030 7003 POLYFLEX AIRWAY 10MM IDX30MM OD 8MM C1874

M00570040 7004 POLYFLEX AIRWAY 10MM IDX40MM OD 8MM C1874

M00570050 7005 POLYFLEX AIRWAY 10MM IDX50MM OD 8MM C1874

M00570060 7006 POLYFLEX AIRWAY 12MM IDX20MM OD 9MM C1874

M00570070 7007 POLYFLEX AIRWAY 12MM IDX30MM OD 9MM C1874

M00570080 7008 POLYFLEX AIRWAY 12MM IDX40MM OD 9MM C1874

M00570090 7009 POLYFLEX AIRWAY 12MM IDX50MM OD 9MM C1874

M00570100 7010 POLYFLEX AIRWAY 14MM IDX20MM OD 9MM C1874

M00570110 7011 POLYFLEX AIRWAY 14MM IDX30MM OD 9MM C1874

M00570120 7012 POLYFLEX AIRWAY 14MM IDX40MM OD 9MM C1874

M00570130 7013 POLYFLEX AIRWAY 14MM IDX50MM OD 9MM C1874

M00570140 7014 POLYFLEX AIRWAY 14MM IDX60MM OD 9MM C1874

M00570150 7015 POLYFLEX AIRWAY 16MM IDX30MM OD 10MM C1874

M00570160 7016 POLYFLEX AIRWAY 16MM IDX40MM OD 10MM C1874

M00570170 7017 POLYFLEX AIRWAY 16MM IDX50MM OD 10MM C1874

M00570180 7018 POLYFLEX AIRWAY 16MM IDX60MM OD 10MM C1874

M00570190 7019 POLYFLEX AIRWAY 16MM IDX70MM OD 10MM C1874

M00570200 7020 POLYFLEX AIRWAY 18MM IDX30MM OD 11MM C1874

M00570210 7021 POLYFLEX AIRWAY 18MM IDX40MM OD 11MM C1874

M00570220 7022 POLYFLEX AIRWAY 18MM IDX50MM OD 11MM C1874

M00570230 7023 POLYFLEX AIRWAY 18MM IDX60MM OD 11MM C1874

M00570240 7024 POLYFLEX AIRWAY 18MM IDX70MM OD 11MM C1874

M00570250 7025 POLYFLEX AIRWAY 18MM IDX80MM OD 11MM C1874

M00570260 7026 POLYFLEX AIRWAY 20MM IDX40MM OD 12MM C1874

M00570270 7027 POLYFLEX AIRWAY 20MM IDX50MM OD 12MM C1874

M00570280 7028 POLYFLEX AIRWAY 20MM IDX60MM OD 12MM C1874

M00570290 7029 POLYFLEX AIRWAY 20MM IDX70MM OD 12MM C1874

M00570300 7030 POLYFLEX AIRWAY 20MM IDX80MM OD 12MM C1874

M00570310 7031 POLYFLEX AIRWAY 22MM IDX50MM OD 13MM C1874

M00570320 7032 POLYFLEX AIRWAY 22MM IDX60MM OD 13MM C1874

M00570330 7033 POLYFLEX AIRWAY 22MM IDX80MM OD 13MM C1874

C1875: Stent, coated/ covered, without delivery systemDevice Name UPN Order # Description CAT Code

Dynamic™ (Y) STENT

M00570670 7067 Dynamic (Y) Stent 11/8mm, 110/25/40 C1875

M00570680 7068 Dynamic (Y) Stent 13/10mm, 110/25/40 C1875

M00570690 7069 Dynamic (Y) Stent 15/12mm, 110/25/40 C1875

Bronchial ThermoplastyC1886: Catheter, extravascular tissue ablation, any modality (insertable)Device Name UPN Order # Description CAT Code

Alair™ Bronchial Thermoplasty Catheter

M005ATS25010 ATS2501 Alair™ Bronchial Thermoplasty Catheter C1886

As of January 1, 2005, the Centers for Medicare and Medicaid Services (CMS) requires hospitals to report all device category codes (C-Codes) on Medicare outpatient claims when medical devices are used in conjunction with procedure(s) billed. If C-Codes are not identified on submitted Medicare outpatient claims, the claims(s) will be returned to the hospital for correction.

Find C-Codes and payment guides for all Boston Scientific products at: http://www.bostonscientific.com/en-US/reimbursement/gastroenterology.html

Also find all available C-Codes at: http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS-Items/2015-Alpha-Numeric-HCPCS-File-%C2%A0.html?DLPage=1&DLSort=0&DLSortDir=descending

CPT Disclaimer CPT copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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ENDO-47411-AD DEC2014