2020PRODUCT CATALOG AND ORDERING INFORMATION...Applicable Medicare C-codes: C1769 - guidewire Sensor PTFE-Nitinol Guidewires with Hydrophilic Tip Order Number GTIN Number Diameter

Urology and Pelvic Health

PRODUCT CATALOG AND ORDERING INFORMATION2020

> VISUALIZATION PRODUCTS

> GUIDEWIRES

> DILATION PRODUCTS

> STONE RETRIEVAL DEVICES

> URETERAL STENTS

> URETERAL CATHETERS

> NEPHROSTOMY PRODUCTS

> LITHOTRIPSY PRODUCTS

> PROSTATE HEALTH

> PROCEDURE ACCESSORIES

> PELVIC FLOOR PRODUCTS

C-CODE CROSS-REFERENCE TO BOSTON SCIENTIFIC PRODUCTS

KEY POINTS OF THE GUIDE

• This document cross-references Boston Scientific products at the UPN/order number level to CMS assigned Category C-codes or indicates there are no applicable C-Codes.

• It also includes a Resource List (see page 84) that cites sources of information on Medicare policy for APCs and the Pass-Through List. Specifically, it highlights Program Memoranda, including those in which the C-codes were published, retired and reinstated; and other notices from CMS.

• See pages 83-84 for more information.

Important-Please note: Health economic and reimbursement information provided by Boston Scientific Corporation is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice. Boston Scientific encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services that are rendered. Boston Scientific recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters. Boston Scientific does not promote the use of its products outside their cleared/approved (as applicable) label.

Boston Scientific Corporation uses a fully computerized order entry system for the convenience of our customers. The system enables Customer Service Representatives to provide you with instant order entry as well as up-to-date order status information.

The system uses UPN order numbers for each product. The bold blue numbers are the old order numbers (see example). Please use either of these numbers when placing an order.

Boston Scientific Customer Service Representatives will be happy to help you with any questions. We are eager to make the ordering procedure as simple and efficient as possible.

ORDERING NUMBERS

Bold Blue Typeis an example of

old order number

Sensor™ Dual-Flex PTFE-Nitinol

OrderNumber

Diameter(in)

Length(cm)

M0066703081 .035 150

M0066703011 .035 150

M0066703121 .038 150

M00667030 21 .038 150

Boston Scientific Confidential – For Internal Use Only. Do Not Copy, Display or Distribute Externally

To place an order, call Boston Scientific Customer Service 1.888.272.1001

1

VISUALIZATION PRODUCTS

LithoVue™ Single-Use Digital Flexible Ureteroscope ................. 5

LithoVue SUD only

LithoVue System Workstation

LithoVue with Image and Video Capture

LithoVue Empower™ Retrieval Deployment Device

LithoVue Empower Bundle

LithoVue Empower Bundle with Basket

LithoVue Service Options

GUIDEWIRES

Sensor™ Guidewires .....................7

Sensor Dual-Flex Nitinol Guidewires with Hydrophilic Tip

Sensor PTFE-Nitinol Guidewires with Hydrophilic Tip

ZIPwire™ Guidewires ....................7

ZIPwire Guidewires (Standard Shaft)

ZIPwire Guidewires (Stiff Shaft)

Zebra™ Guidewires ...................... 8

Zebra Guidewires

PTFE Coated Guidewires ............. 9

PTFE Coated Guidewires (Fixed Core)

PTFE Coated Guidewires (Fixed Core, Stiff Bodied)

PTFE Coated Guidewires (Moveable Core)

Amplatz Super Stiff™ Coated Guidewires

Lubriglide™ Coated Guidewires ..10

Lubriglide Coated Guidewires (Fixed Core)

Lubriglide Coated Guidewires (Fixed Core, Stiff Bodied)

Lubriglide Coated Guidewires (Moveable Core)

DILATION PRODUCTS

Ureteral Access Sheaths ............. 13

Navigator™ HD Ureteral Access Sheath Sets

Navigator Ureteral Access Sheath Sets

Ureteral Balloon Dilation Catheters ....................................14

UroMax Ultra™ Balloon Dilatation Catheters

Passport™ Balloon Dilatation Catheters

Encore™ 26 Inflator

Ureteral Dilators .........................16

Nottingham One-Step Hydrogel Coated Ureteral Dilators

Ureteral Dilator System with Procedural Sheath Set

Ureteral Dilatation Set

Ureteral Dilators

STONE RETRIEVAL DEVICES

Nitinol Retrieval Devices ............19

Zero Tip™ Nitinol Stone Retrieval Baskets

Dakota™ Nitinol Stone Retrieval Devices

Escape™ Nitinol Stone Retrieval Baskets

OptiFlex™ Nitinol Stone Retrieval Baskets

Graspit™ Nitinol Stone Retrieval Forceps

Stainless Steel Retrieval Devices...20

Bagley Helical Stone Retrieval Baskets

Gemini™ Paired Wire Helical Stone Retrieval Baskets

Segura Hemisphere™ Stone Retrieval Baskets

Tricep™ Hooked-Prong Grasping Forceps

Tricep Hooked-Prong Grasping Forceps with Spool Handle

Leslie Parachute™ Multi-Wire Stone Sweeping Devices

LithoCatch™ Immobilization Device

Antiretropulsion Devices ...........23

Stone Cone™ Nitinol Urological Retrieval Coils

URETERAL STENTS

Stent Store ..................................25

Tria™ Ureteral Stent

Polaris™ Ultra Ureteral Stent Sets

Polaris Loop Ureteral Stent Sets

Percuflex™ Plus Ureteral Stent Sets

Percuflex Ureteral Stents

Contour™ Ureteral Stent Sets

Contour Injection Stent Sets

Mardis Soft Ureteral Stent Sets

Stretch™ VL Flexima™ Ureteral Stent Sets

URETERAL STENTS AND SETS .... 40

Retromax™ Plus Endopyelotomy Stents

Percuflex™ Urinary Diversion Stent Sets

STENT ACCESSORIES ...................41

Ureteral Stent Positioners

Table of Contents Urology and Pelvic Health

( Table of Contents 1 of 3 )


2

URETERAL CATHETERS

Torqueable Catheters ................ 43

Dual Lumen Ureteral Catheter

Imager™ II Urology Torque Catheters

Ureteral Catheters: Open End Ureteral Catheters

Ureteral Catheters: Angled Tip Ureteral Catheters

Axxcess™ Catheter: Open End Ureteral Catheter

C-Flex™ Ureteral Catheters: Flexible Tip Open End Ureteral Catheter Sets

C-Flex Ureteral Catheters: Open End Ureteral Catheter Sets

C-Flex Ureteral Catheters: Pigtail Ureteral Catheter Sets

NEPHROSTOMY PRODUCTS

Percutaneous Kits ..................... 49

Lingeman Percutaneous Tract Kit with ZIPwire™ Guidewire

Percutaneous Tract Kit with ZIPwire Guidewire

Percutaneous Access Set

Percutaneous Access Sets – Pigtail Catheter

Introducer Sets .......................... 50

NaviGuide™ Percutaneous Access Needle

TLA Introducer Needle and Sheath Set

Balloon Dilation Catheters ........ 50

NephroMax™ High Pressure Nephrostomy Balloon Catheters

Inflation Devices .........................51


Dilators And Sheaths .................51

Clear Renal Sheath

Amplatz Type Renal Dilator/Sheath Set

Amplatz Type Graduated Renal Dilation Set

Amplatz Type Renal Dilators

Amplatz Type Renal Sheath

8/10 Dilator/Sheath Set

Torqueable Catheters ................ 54


Occlusion Balloon Catheters ..... 54

Occluder™ Occlusion Balloon Catheters

Drainage Catheters ....................55

Malecot Nephrostomy Catheters

Re-Entry™ Malecot Nephrostomy Catheter Sets

Percuflex™ Locking Loop All Purpose Drainage Catheters with Fader Tip™

Percuflex Locking Loop Nephrostomy Catheters with Fader Tip™

Percuflex Combination Stent/Nephrostomy Catheter

Percuflex Locking Loop Nephrostomy Catheters

LITHOTRIPSY PRODUCTS

Laser Systems............................ 59

Lumenis™ Laser Systems

Lumenis Pulse™ 120H Moses Upgrade

Laser Fibers ............................... 59

Flexiva™ TracTip™ High Power Single-Use Laser Fibers

Flexiva High Power Single-Use Laser Fibers

Flexiva ID High Power Single-Use Laser Fibers

AccuTrac™ Single-Use Holmium Laser Fibers

AccuMax™ Single-Use Holmium Laser Fibers

Moses™ Laser Fibers

SlimLine EZ™ SIS Single-Use Laser Fibers

SlimLine™ SIS Reusable Laser Fibers

Laser Accessories .......................61

Accessories for Lumenis Brand Holmium and Dual Wavelength Laser Systems

Dual-Energy Lithotripter Systems ..................................... 62

Swiss LithoClast™ Trilogy System Kit

Swiss LithoClast Trilogy Single-Use Probe Kits

Swiss LithoClast Trilogy System Accessories

Swiss LithoClast Trilogy Single-Use Accessories

Swiss LithoClast Trilogy Cart

Trilogy Service Options

Swiss LithoClast Select Accessories

Swiss LithoClast Ultrasound Probes

Swiss LithoClast Pneumatic Probes

Swiss LithoClast Service Options




3

PROSTATE HEALTH

BPH Laser Systems .....................67

GreenLight™ Laser Therapy

Rezūm™ Water Vapor Therapy

Holmium Laser Therapy

Forceps ...................................... 68

Piranha™ 3 French Ureteroscopic Biopsy Forcep

Suture Capturing Devices ......... 68

Capio™ RP Suturing Devices for Radical Prostatectomy

Perirectal Hydrogel Spacer ....... 69

SpaceOAR™ Hydrogel

PROCEDURE ACCESSORIES

Inflation Device ..........................71


Bladder Evacuation Device ........71

Urovac™ Bladder Evacuator

Irrigation Devices and Accessories ..........................72

SAPS™ Single Action Pumping System

SAPS™ CF Continuous Flow Single Action Pumping System

Other ..........................................73

UroLok™ II Scope Adaptor

ESP™ Radiation Reduction Examination Gloves

Connecting Tubes

Ureteral Catheter Connectors

Drainage Bag Connectors

Gateway™ Advantage Y-Adapter

PELVIC FLOOR PRODUCTS

Mid-Urethral Sling Systems .......75

Advantage Fit™ System (Transvaginal)

Advantage™ System (Transvaginal)

Lynx™ System (Suprapubic)

Obtryx™ II System with PrecisionBlue™ Design Halo or Curved (Transobturator)

Obtryx System Halo or Curved (Transobturator)

Solyx™ SIS System (Single Incision)

Injectable Implant ......................76

Coaptite™ Injectable Implant

Suturing Systems .......................77

Capio™ Slim Suture Capturing Device

Capio Suture Capturing Devices

Capio Sutures

Sacrocolpopexy ......................... 78

Upsylon™ Y-Mesh

Polyform™ Synthetic Mesh

Pelvic Floor Accessories ............ 78

Single-Step™ Pelvic Drape




4

NOTES

VISUA

LIZATIONPRODU

CTS

For Position Only.Insert Tab here.

This Page does not print

VISU

ALI

ZATI

ONPR

ODU

CTS




5


LITHOVUE™ SINGLE-USE DIGITAL FLEXIBLE URETEROSCOPE

LithoVue SUD only

Order Number GTIN Number Description Unit

M0067913500 8714729874805 LithoVue - Global Standard ea

M0067913600 8714729874812 LithoVue - Global Reverse ea

Applicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

LithoVue System Workstation


M0067911000 8714729874522 LithoVue System Workstation - Global ea


LithoVue with Image and Video Capture


M0067913900 04907034602001 TEAC UR-4MD ea


LithoVue Empower™ Retrieval Deployment Device


M0067919900 08714729977612 LithoVue Empower ea


LithoVue Empower Bundle


M00679135SB N/A LithoVue Standard w/ Empower ea

M00679136SB N/A LithoVue Reverse w/ Empower ea


(Includes Touch PC, Cart, Power Cord and User's Manual)



6


LITHOVUE™ SINGLE-USE DIGITAL FLEXIBLE URETEROSCOPE (Continued)

LithoVue Empower™ Bundle with Basket


M0067913510SB N/A LithoVue Standard w/ Dakota 8mm ea

M0067913520SB N/A LithoVue Standard w/ Dakota 11mm ea

M0067913530SB N/A LithoVue Standard w/ Ztip 1.9f x 120cm ea

M0067913610SB N/A LithoVue Reverse w/ Dakota 8mm ea

M0067913620SB N/A LithoVue Reverse w/ Dakota 11mm ea

M0067913630SB N/A LithoVue Reverse w/ Ztip 1.9f x 120cm ea


LithoVue Service Options

Order Number Description

SRVM006LITPOST1 LithoVue EssentialCare 1 YR POST






GUIDEW

IRES



GUID

EWIR

ES




7

GUIDEWIRES

SENSOR™ GUIDEWIRES

Sensor Dual-Flex Nitinol Guidewires with Hydrophilic Tip

Order Number GTIN NumberDiameter

(in)Length

(cm)Tip Design

UnitShape StyleM0066703081 08714729302681 .035 150 Straight 3cm Flexible bx 5M0066703011 08714729302612 .035 150 Angled 3cm Flexible bx 5M0066703121 08714729257349 .038 150 Straight 3cm Flexible bx 5M00667030 21 08714729302629 .038 150 Angled 3cm Flexible bx 5Applicable Medicare C-codes: C1769 - guidewire

Sensor PTFE-Nitinol Guidewires with Hydrophilic Tip

OrderNumber

GTINNumber

Diameter(in)

Length(cm)

Tip DesignUnit

Shape StyleM0066703051 08714729302650 .035 150 Straight 3cm Flexible bx 5M0066703061 08714729302667 .035 150 Angled 3cm Flexible bx 5M0066703091 08714729257318 .038 150 Straight 3cm Flexible bx 5M0066703101 08714729257325 .038 150 Angled 3cm Flexible bx 5Applicable Medicare C-codes: C1769 - guidewire

ZIPWIRE™ GUIDEWIRES

Bentson-Type

Angled tip

Straight tip

ZIPwire Guidewires (Standard Shaft)


(in)Length

(cm)Tip Design

UnitShape StyleM006630200B1 08714729802433 .018 150 Straight 3cm Flexible bx 5M006630201B1 08714729802457 .025 150 Straight 3cm Flexible bx 5M006630202B1 08714729802440 .025 150 Angled 3cm Flexible bx 5M006630212B1 08714729839149 .032 150 Straight 3cm Flexible bx 5M006630213B1 08714729839156 .032 150 Angled 3cm Flexible bx 5M006630205B1 08714729761761 .035 150 Straight 3cm Flexible bx 5M006630206B1 08714729761778 .035 150 Angled 3cm Flexible bx 5M006630208B1 08714729755333 .038 150 Straight 3cm Flexible bx 5M006630209B1 08714729761785 .038 150 Angled 3cm Flexible bx 5M006630210B1 08714729802556 .038 260 Straight 3cm Flexible bx 5Applicable Medicare C-codes: C1769 - guidewire

(10cm Flexible Proximal End)



8

GUIDEWIRES

ZIPWIRE™ GUIDEWIRES (Continued)

ZIPwire Guidewires (Standard Shaft) (continued)


(in)Length

(cm)

Tip Design

UnitShape Style

M006630214B1 08714729839163 .035 150 Straight Bentson 8cm Flexible bx 5

M006630203B1 08714729802464 .035 150 Angled Bentson 8cm Flexible bx 5



Applicable Medicare C-codes: C1769 - guidewire

ZIPwire Guidewires (Stiff Shaft)


(in)Length

(cm)

Tip Design

UnitShape Style

M006630216B1 08714729839187 .025 150 Straight 3cm Flexible bx 5

M006630217B1 08714729839194 .025 150 Angled 3cm Flexible bx 5










ZEBRA™ GUIDEWIRES

Zebra Guidewires


(in)Length

(cm)

Tip Design

UnitShape Style

M0066701081 08714729191216 .025 150 Straight 3cm Flexible bx 5

M0066701091 08714729191223 .025 150 Angled 3cm Flexible bx 5







Supplied with Torque ViseApplicable Medicare C-codes: C1769 - guidewire



9

GUIDEWIRES

PTFE COATED GUIDEWIRES

PTFE Coated Guidewires (Fixed Core)


(in)Length

(cm)

Tip Design

UnitShape Style

M0066201070 08714729077046 .025 150 Straight 3cm Flexible ea


M0066201250 08714729056669 .035 150 Straight 15cm Flexible; Bentson-Type ea




PTFE Coated Guidewires (Fixed Core, Stiff Bodied)


(in)Length

(cm)

Tip Design

UnitShape Style



M0066201110 08714729077077 .035 150 3mm “J” ea


M0066201020 08714729005735 .038 150 3mm “J” ea


PTFE Coated Guidewires (Moveable Core)


(in)Length

(cm)Tip Design

Shape Unit

M0066201300 08714729057093 .035 150 Straight ea

M0066201210 08714729077084 .035 150 3mm “J” ea

M0066201030 08714729012627 .038 150 Straight ea

M0066201220 08714729077091 .038 150 3mm “J” ea


Amplatz Super Stiff™ Coated Guidewires


(in)Length

(cm)

Tip Design

UnitShape Style

M0066401041 08714729191148 .035 145 Straight 7cm Flexible, Bentson-Type bx 5

M0066401051 08714729191155 .035 145 3mm “J” bx 5

M0066401081 08714729191186 .035 145 Straight 3.5cm Flexible bx 5

M0066401061 08714729191162 .038 145 Straight 6cm Flexible, Bentson-Type bx 5

M0066401071 08714729191179 .038 145 3mm “J” bx 5

M0066401091 08714729191193 .038 145 Straight 3.5cm Flexible bx 5




10

GUIDEWIRES

LUBRIGLIDE™ COATED GUIDEWIRES

Lubriglide Coated Guidewires (Fixed Core)


(in)Length

(cm)

Tip Design

UnitShape Style


M0066001060 08714729012603 .032 150 Straight18cm Coil with 3cm Flexible;

Lunderquist-Typeea





Lubriglide Coated Guidewires (Fixed Core, Stiff Bodied)


(in)Length

(cm)

Tip Design

UnitShape Style



Lubriglide Coated Guidewires (Moveable Core)


(in)Length

(cm)Tip Design

Shape Unit

M0066001300 08714729057062 .035 150 Straight ea

M0066001030 08714729011392 .038 150 Straight ea




11

NOTES


12

NOTES

DILATIONPRODU

CTS



DILA

TION

PROD

UCT

S




13

DILATION PRODUCTS

URETERAL ACCESS SHEATHS

Single-Tapered Tip

Navigator™ HD Ureteral Access Sheath Sets

Order Number GTIN Number French Size Length (cm) Unit

M0062502210 08714729839064 11/13 28 ea

M0062502220 08714729837978 11/13 36 ea

M0062502230 08714729837985 11/13 46 ea

M0062502240 08714729838272 12/14 28 ea

M0062502250 08714729837992 12/14 36 ea

M0062502260 08714729837558 12/14 46 ea

M0062502270 08714729839071 13/15 28 ea

M0062502280 08714729839088 13/15 36 ea

M0062502290 08714729839095 13/15 46 ea

Applicable Medicare C-codes: C1894 - introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser

Navigator Ureteral Access Sheath Sets

Order Number GTIN Number French Size Length (cm) Unit

M0062502000 08714729429920 11/13 28 ea

M0062502020 08714729429944 11/13 36 ea

M0062502040 08714729429968 11/13 46 ea

M0062502060 08714729470359 13/15 28 ea

M0062502080 08714729429999 13/15 36 ea

M0062502100 08714729430018 13/15 46 ea

M0062502011 08714729469575 11/13 28 bx 5

M0062502031 08714729469582 11/13 36 bx 5

M0062502051 08714729469599 11/13 46 bx 5

M0062502071 08714729469605 13/15 28 bx 5

M0062502091 08714729469612 13/15 36 bx 5

M0062502111 08714729469629 13/15 46 bx 5




14

DILATION PRODUCTS

URETERAL BALLOON DILATION CATHETERS

UroMax Ultra™ Balloon Dilatation Catheters

Order Number GTIN Number

Balloon Inflated O.D.

BalloonLength

(cm)

Catheter SizeUsableLength

(cm)

RecommendedGuidewire

(in) Unit(Fr) (mm) (Fr) (mm)M0062251200 08714729341277 12 4 4 5.8 1.9 75 .038 ea

M0062251210 08714729341284 15 5 4 5.8 1.9 75 .038 eaM0062251220 08714729341291 18 6 4 5.8 1.9 75 .038 eaM0062251230 08714729341307 21 7 4 5.8 1.9 75 .038 eaM0062251240 08714729341314 24 8 4 5.8 1.9 75 .038 eaM0062251250 08714729341321 30 10 4 5.8 1.9 75 .038 eaM0062251260 08714729341338 12 4 6 5.8 1.9 75 .038 eaM0062251270 08714729341345 15 5 6 5.8 1.9 75 .038 eaM0062251280 08714729341352 18 6 6 5.8 1.9 75 .038 eaM0062251290 08714729341369 21 7 6 5.8 1.9 75 .038 eaM0062251300 08714729341376 24 8 8 5.8 1.9 75 .038 eaM0062251310 08714729341383 30 10 8 5.8 1.9 75 .038 eaM0062251350 08714729341390 12 4 10 5.8 1.9 75 .038 eaM0062251360 08714729302421 15 5 10 5.8 1.9 75 .038 eaM0062251370 08714729302438 18 6 10 5.8 1.9 75 .038 eaM0062251380 08714729302445 21 7 10 5.8 1.9 75 .038 eaKit Includes: UroMax Ultra High Pressure Balloon Dilatation Catheter, Encore™ 26 InflatorApplicable Medicare C-codes: C1726 - catheter, balloon dilatation, non-vascular

UroMax Ultra Balloon Dilatation Catheters



BalloonLength

(cm)


(cm)

RecommendedGuidewire

(in) Unit(Fr) (mm) (Fr) (mm)M0062251000 08714729341109 12 4 4 5.8 1.9 75 .038 eaM0062251010 08714729341116 15 5 4 5.8 1.9 75 .038 eaM0062251020 08714729341123 18 6 4 5.8 1.9 75 .038 eaM0062251030 08714729341130 21 7 4 5.8 1.9 75 .038 eaM0062251040 08714729341147 24 8 4 5.8 1.9 75 .038 eaM0062251050 08714729341154 30 10 4 5.8 1.9 75 .038 eaM0062251060 08714729341161 12 4 6 5.8 1.9 75 .038 eaM0062251070 08714729341178 15 5 6 5.8 1.9 75 .038 eaM0062251080 08714729341185 18 6 6 5.8 1.9 75 .038 eaM0062251090 08714729341192 21 7 6 5.8 1.9 75 .038 eaM0062251100 08714729341208 24 8 8 5.8 1.9 75 .038 eaM0062251110 08714729341222 30 10 8 5.8 1.9 75 .038 eaM0062251150 08714729341239 12 4 10 5.8 1.9 75 .038 eaM0062251160 08714729341246 15 5 10 5.8 1.9 75 .038 eaM0062251170 08714729341253 18 6 10 5.8 1.9 75 .038 eaM0062251180 08714729341260 21 7 10 5.8 1.9 75 .038 eaApplicable Medicare C-codes: C1726 - catheter, balloon dilatation, non-vascular

(Kits)



15

DILATION PRODUCTS

URETERAL BALLOON DILATION CATHETERS (Continued)

Passport™ Balloon Dilatation Catheters



BalloonLength

(cm)

TipLength

(cm)

ShaftDiameter

(Fr)

UsableLength

(cm) Unit(Fr) (mm)

M0062181200 08714729042570 12 4 2 2 3.0 150 ea

M0062181210 08714729042587 12 4 2 4 3.0 150 ea

M0062181300 08714729042594 12 4 4 2 3.0 150 ea

M0062181310 08714729042600 12 4 4 4 3.0 150 ea

Kit Includes: Passport Balloon Dilatation Catheter and Encore™ 26 InflatorApplicable Medicare C-codes: C1726 - catheter, balloon dilatation, non-vascular

Passport Balloon Dilatation Catheters



BalloonLength

(cm)

TipLength

(cm)

ShaftDiameter

(Fr)

UsableLength

(cm) Unit(Fr) (mm)

M0062181000 08714729154921 12 4 2 2 3.0 150 ea

M0062181010 08714729042549 12 4 2 4 3.0 150 ea

M0062181100 08714729191872 12 4 4 2 3.0 150 ea

M0062181110 08714729154969 12 4 4 4 3.0 150 ea

Applicable Medicare C-codes: C1726 - catheter, balloon dilatation, non-vascular



M0067101131 08714729761815 20ml Encore 26 Inflator with Pressure Gauge bx 5

M0067101140 08714729755814 20ml Encore 26 Inflator with Pressure Gauge ea


(Kits)



16

DILATION PRODUCTS

URETERAL DILATORS

Nottingham One-Step Hydrogel Coated Ureteral Dilators

Order Number GTIN NumberTaper Size From/To

(Fr)Taper Length

(cm)Usable Length

(cm) Unit

M0062301000 08714729192053 6/10 4 70 ea

M0062301010 08714729012443 6/12 4 70 ea

M0062301100 08714729192060 10/16 4 70 ea

M0062301150 08714729192077 12/18 4 70 ea


Ureteral Dilator System with Procedural Sheath Set


M0062501000 08714729192091 Ureteral Dilators and Procedural Sheath Set ea

Set Includes: One 6, 8, 10, 12, and 14 Fr C-Flex™ Radiopaque Dilator with HydroPlus™ Coating; One 16 Fr O.D., 14 Fr I.D. x 37.5cm Length Radiopaque PTFE Procedural Sheath; .038” PTFE Coated GuidewireApplicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

Ureteral Dilatation Set


M0062401000 08714729005322 Ureteral Dilatation Set ea

Set Includes: One 6, 8, 10, 12, 14, and 16 Fr C-Flex Radiopaque Dilator with HydroPlus Coating and .038” PTFE Coated GuidewireApplicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

Ureteral Dilators

Order Number GTIN NumberO.D. Size

(Fr)Usable Length

(cm) Unit

M0062401100 08714729005339 6 70 ea

M0062401110 08714729192084 8 70 ea

M0062401120 08714729005353 10 70 ea

M0062401130 08714729005360 12 70 ea

M0062401140 08714729005377 14 70 ea

M0062401150 08714729005384 16 70 ea




17

NOTES


18

NOTES

STONE R

ETRIEVA

LDEVICES



STON

E R

ETR

IEVA

LDE

VICE

S




19


NITINOL RETRIEVAL DEVICES

4-wire “O” Tip

Zero Tip™ Nitinol Stone Retrieval Baskets

Order Number GTIN NumberSheath O.D.

(Fr)Working Length

(cm)Basket O.D.

(mm)Sheath

Material Unit

M0063901040 08714729469636 1.9 90 12 Polyimide/PTFE ea






Includes: IntroducerApplicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

Dakota™ Nitinol Stone Retrieval Devices


(Fr)Working Length

(cm)Basket O.D.

(mm) Unit

M0063905000 08714729937364 1.9 120 8 ea

M0063905010 08714729937371 1.9 120 11 ea


1.9Fr

“O” Tip

Positive Action Detachable Handle

Positive Action Detachable HandlePositive Action Detachable Handle

Escape™ Nitinol Stone Retrieval Baskets


(Fr)Working Length

(cm)Basket O.D.

(mm) Unit

M0063902000 08714729121282 1.9 90 11–15 ea

M0063902010 08714729121299 1.9 120 11–15 ea

Includes: Y-Adaptor, T-ConnectorApplicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.



20


NITINOL RETRIEVAL DEVICES (Continued)

OptiFlex™ Nitinol Stone Retrieval Baskets


(Fr)Working Length

(cm)Basket O.D.

(mm) Unit

M0063903000 08714729767596 1.3 90 11 ea

M0063903010 08714729772859 1.3 120 11 ea


Graspit™ Nitinol Stone Retrieval Forceps


(Fr)Working Length

(cm)Basket O.D.

(mm)Sheath

Material Unit






STAINLESS STEEL RETRIEVAL DEVICES

Bagley Helical Stone Retrieval Baskets


(Fr)Working Length

(cm)Basket O.D.

(mm) Unit

M0063401210 08714729043478 1.9 90 10 ea

M0063401220 08714729043485 1.9 120 10 ea




21


STAINLESS STEEL RETRIEVAL DEVICES (Continued)

Gemini™ Paired Wire Helical Stone Retrieval Baskets

Order Number GTIN Number DescriptionSheath O.D.

(Fr)Working Length

(cm)Basket O.D.

(mm) Unit

M0063303040 08714729074281 3 Wire Basket, “O” Tip 2.4 90 11 ea


M0063303070 08714729074311 3 Wire Basket, 5cm Filiform Tip 2.4 120 11 ea


























22



Segura Hemisphere™ Stone Retrieval Baskets


(Fr)Working Length

(cm)Basket O.D.

(mm)Sheath

Material Unit

M0063801060 08714729341901 4 Wire Basket, “O” Tip 2.4 90 16 Polyimide ea






M0063801160 08714729341963 4 Wire Basket, “O” Tip 4.5 90 16 PTFE ea

M0063801180 08714729341970 4 Wire Basket, “O” Tip 4.5 90 20 PTFE ea

M0063801190 08714729341987 4 Wire Basket, 5cm Filiform Tip 4.5 90 20 PTFE ea


Tricep™ Hooked-Prong Grasping Forceps


(Fr)Working Length

(cm)Sheath

Material Unit

M0063701100 08714729192183 Retracting Grasping Forceps 2.4 90 PTFE ea


M0063701000 08714729192176 3-Prong Mini-Throw Grasping Forceps 3.0 90 PTFE ea

M0063701010 08714729163770 3-Prong Mini-Throw Grasping Forceps 3.0 120 PTFE ea



M0063701220 08714729192244 Extra-Strength Grasping Forceps 3.0 90 Polyimide ea

M0063701230 08714729192251 Extra-Strength Grasping Forceps 3.0 120 Polyimide ea


Tricep Hooked-Prong Grasping Forceps with Spool Handle


(Fr)Working Length

(cm)Sheath

Material Unit

M0063701180 08714729192220 Non-Retracting Grasping Forceps 3.0 90 Polyimide ea

M0063701190 08714729192237 Non-Retracting Grasping Forceps 3.0 120 Polyimide ea




23



Leslie Parachute™ Multi-Wire Stone Sweeping Devices

Order Number GTIN Number Tip ConfigurationSheath O.D.

(Fr)Working Length

(cm)Basket O.D.

(cm) Unit

M0063203000 08714729162025 “O” Tip 3.1 90 10.5 ea

M0063203010 08714729162032 5cm Filiform Tip 3.1 90 10.5 ea

M0063203020 08714729162049 “O” Tip 3.1 120 10.5 ea

M0063203030 08714729162056 5cm Filiform Tip 3.1 120 10.5 ea


LithoCatch™ Immobilization Device


(Fr)Working Length

(cm)Basket O.D.

(mm)Sheath

Material Unit



ANTIRETROPULSION DEVICES

Coil

Sheath Radiopaque Marker

Stone Cone™ Nitinol Urological Retrieval Coils


(Fr)Working Length

(cm)O.D.(mm)

SheathMaterial Unit

M0063903100 08714729430209 3.0 115 7 PTFE ea

M0063903200 08714729430223 3.0 115 10 PTFE ea

Includes: J-IntroducerApplicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.



24

NOTES

UR

ETERA

LSTEN

TS



UR

ETER

AL

STEN

TS




25

URETERAL STENTS

STENT STORE

Tria™ Ureteral Stent

French Size x Length Between Pigtails

Tria Soft (Without Guidewire)

Tria Firm(Without Guidewire)

Order Number GTIN Number Order Number GTIN Number

4.8 x 10 N/A N/A M0061902050 8714729937715

4.8 x 12 N/A N/A M0061902060 8714729937722

4.8 x 14 N/A N/A M0061902070 8714729937739

4.8 x 16 N/A N/A M0061902080 8714729937746

4.8 x 18 N/A N/A M0061902090 8714729937753

4.8 x 20 N/A N/A M0061902100 8714729937760

4.8 x 22 N/A N/A M0061902110 8714729937777

4.8 x 24 N/A N/A M0061902120 8714729937784

4.8 x 26 N/A N/A M0061902130 8714729937791

4.8 x 28 N/A N/A M0061902140 8714729937807

4.8 x 30 N/A N/A M0061902150 8714729937814

6 x 20 M0061903200 8714729953951 M0061902200 8714729937821

6 x 22 M0061903210 8714729959885 M0061902210 8714729937838

6 x 24 M0061903220 8714729959892 M0061902220 8714729937845

6 x 26 M0061903230 8714729959908 M0061902230 8714729937852

6 x 28 M0061903240 8714729959915 M0061902240 8714729937869

6 x 30 M0061903250 8714729953968 M0061902250 8714729937876

7 x 20 M0061903300 8714729953982 M0061902300 8714729937883

7 x 22 M0061903310 8714729959922 M0061902310 8714729937890

7 x 24 M0061903320 8714729959939 M0061902320 8714729937906

7 x 26 M0061903330 8714729959946 M0061902330 8714729937913

7 x 28 M0061903340 8714729959953 M0061902340 8714729937920

7 x 30 M0061903350 8714729953999 M0061902350 8714729937937

8 x 20 M0061903400 8714729954019 M0061902400 8714729937944

8 x 22 M0061903410 8714729959960 M0061902410 8714729937951

8 x 24 M0061903420 8714729959977 M0061902420 8714729937968

8 x 26 M0061903430 8714729959984 M0061902430 8714729937975

8 x 28 M0061903440 8714729959991 M0061902440 8714729937982

8 x 30 M0061903450 8714729954026 M0061902450 8714729937999

N/A = Not Available

#1Boston Scientific Confidential – For Internal Use Only. Do Not Copy, Display or Distribute Externally


26

URETERAL STENTS

STENT STORE (Continued)

Polaris™ Ultra Ureteral Stent Sets

French Size x Length Between Pigtails Without Wire

.035" Sensor PTFE-Nitinol Flexible Straight Tip

.038" Sensor PTFE-Nitinol

Dual-Flex Straight Tip

Order Number GTIN Number Order Number GTIN Number Order Number GTIN Number

5 x 10 M0061921110 08714729125372 M006192111090 08714729125389 N/A N/A

5 x 12 M0061921120 08714729125402 M006192112090 08714729125419 N/A N/A

5 x 14 M0061921130 08714729125426 M006192113090 08714729125433 N/A N/A

5 x 16 M0061921140 08714729125440 M006192114090 08714729125457 N/A N/A

5 x 18 M0061921150 08714729125464 M006192115090 08714729125471 N/A N/A

5 x 20 M0061921200 08714729124269 M006192120090 08714729124276 N/A N/A

5 x 22 M0061921210 08714729124283 M006192121090 08714729124290 M006192121120 08714729766278

5 x 24 M0061921220 08714729124306 M006192122090 08714729124313 M006192122120 08714729766308

5 x 26 M0061921230 08714729124320 M006192123090 08714729124337 M006192123120 08714729766339

5 x 28 M0061921240 08714729124344 M006192124090 08714729124351 M006192124120 08714729766360

5 x 30 M0061921250 08714729124368 M006192125090 08714729124375 N/A N/A

6 x 20 M0061921300 08714729124382 M006192130090 08714729124399 N/A N/A

6 x 22 M0061921310 08714729124405 M006192131090 08714729124412 M006192131120 08714729766452

6 x 24 M0061921320 08714729124429 M006192132090 08714729124436 M006192132120 08714729766483

6 x 26 M0061921330 08714729124443 M006192133090 08714729124450 M006192133120 08714729766513

6 x 28 M0061921340 08714729124467 M006192134090 08714729124474 M006192134120 08714729766544

6 x 30 M0061921350 08714729124498 M006192135090 08714729124856 N/A N/A

7 x 20 M0061921400 08714729124504 M006192140090 08714729124511 N/A N/A

7 x 22 M0061921410 08714729124528 M006192141090 08714729124535 N/A N/A

7 x 24 M0061921420 08714729124542 M006192142090 08714729124559 M006192142120 08714729766667

7 x 26 M0061921430 08714729124566 M006192143090 08714729124573 M006192143120 08714729766698

7 x 28 M0061921440 08714729124580 M006192144090 08714729124597 N/A N/A

7 x 30 M0061921450 08714729124603 M006192145090 08714729124610 N/A N/A

8 x 20 M0061921500 08714729124627 M006192150090 08714729124634 N/A N/A

8 x 22 M0061921510 08714729124641 M006192151090 08714729124658 N/A N/A

8 x 24 M0061921520 08714729125150 M006192152090 08714729124672 M006192152120 08714729766841

8 x 26 M0061921530 08714729720942 M006192153090 08714729720959 M006192153120 08714729766872

8 x 28 M0061921540 08714729124702 M006192154090 08714729124719 N/A N/A

8 x 30 M0061921550 08714729124726 M006192155090 08714729124733 N/A N/A

Each Stent Supplied with Attached Braided Retrieval Line and Stent PositionerSet Includes: Polaris Ultra Dual Durometer Ureteral Stent, Stent Positioner, Axxcess™ 6Fr Ureteral Catheter, and Specified GuidewireN/A = Not AvailableApplicable Medicare C-codes: C2617 - stent, non-coronary, temporary, without delivery system; C1769 - guidewire; C1758 - catheter, ureteral

(Dual Durometer Percuflex™ Material with HydroPlus™ Coating)



27

URETERAL STENTS


Polaris™ Ultra Ureteral Stent Sets (Dual Durometer Percuflex™ Material with HydroPlus™ Coating) (Continued)

FrenchSize x LengthBetweenPigtails

.035"ZIPwire

Straight 3cmFlexible Tip

.035" Stiff ShaftZIPwire


.038"ZIPwire™


.035" Stiff ShaftPTFE



Straight 3cm Flexible Tip

Order Number

GTIN NumberOrder

NumberGTIN Number

Order Number

GTIN NumberOrder

NumberGTIN Number

Order Number

GTIN Number

5 x 10 N/A N/A M006192111180 08714729776963 N/A N/A M006192111050 08714729798873 M006192111010 08714729789734

5 x 12 M006192112190 08714729766148 M006192112180 08714729776970 M006192112170 08714729766131 M006192112050 08714729798880 M006192112010 08714729781301

5 x 14 M006192113190 08714729766179 M006192113180 08714729776987 M006192113170 08714729766162 M006192113050 08714729798897 M006192113010 08714729781318

5 x 16 M006192114190 08714729766209 N/A N/A M006192114170 08714729766193 M006192114050 08714729798903 M006192114010 08714729784821

5 x 18 M006192115190 08714729766230 N/A N/A M006192115170 08714729766223 M006192115050 08714729798910 N/A N/A

5 x 20 M006192120190 08714729766261 M006192120180 08714729777014 M006192120170 08714729766254 M006192120050 08714729798927 M006192120010 08714729790259

5 x 22 M006192121190 08714729766292 M006192121180 08714729777021 M006192121170 08714729766285 M006192121050 08714729798934 M006192121010 08714729779483

5 x 24 M006192122190 08714729766322 M006192122180 08714729777038 M006192122170 08714729766315 M006192122050 08714729780410 M006192122010 08714729784272

5 x 26 M006192123190 08714729766353 M006192123180 08714729777045 M006192123170 08714729766346 M006192123050 08714729780427 M006192123010 08714729779537

5 x 28 M006192124190 08714729766384 M006192124180 08714729777052 M006192124170 08714729766377 M006192124050 08714729784296 M006192124010 08714729784289

5 x 30 N/A N/A N/A N/A M006192125170 08714729766407 M006192125050 08714729798941 N/A N/A

6 x 20 M006192130190 08714729766445 M006192130180 08714729777076 M006192130170 08714729766438 M006192130050 08714729798958 M006192130010 08714729779490

6 x 22 M006192131190 08714729766476 M006192131180 08714729777083 M006192131170 08714729766469 M006192131050 08714729798965 M006192131010 08714729782995

6 x 24 M006192132190 08714729766506 M006192132180 08714729777090 M006192132170 08714729766490 M006192132050 08714729784319 M006192132010 08714729784302

6 x 26 M006192133190 08714729766537 M006192133180 08714729777106 M006192133170 08714729766520 M006192133050 08714729778219 M006192133010 08714729779520

6 x 28 M006192134190 08714729766568 M006192134180 08714729777113 M006192134170 08714729766551 M006192134050 08714729784326 M006192134010 08714729779476

6 x 30 M006192135190 08714729766599 M006192135180 08714729777120 M006192135170 08714729766582 M006192135050 08714729784197 M006192135010 08714729798842

7 x 20 N/A N/A M006192140180 08714729777137 M006192140170 08714729766612 M006192140050 08714729784333 N/A N/A

7 x 22 M006192141190 08714729766650 M006192141180 08714729777144 M006192141170 08714729766643 M006192141050 08714729798972 M006192141010 08714729779506

7 x 24 M006192142190 08714729766681 M006192142180 08714729777151 M006192142170 08714729766674 M006192142050 08714729798989 M006192142010 08714729784340

7 x 26 M006192143190 08714729766711 M006192143180 08714729777168 M006192143170 08714729766704 M006192143050 08714729784364 M006192143010 08714729784357

7 x 28 M006192144190 08714729766742 M006192144180 08714729777175 M006192144170 08714729766735 M006192144050 08714729798996 M006192144010 08714729784371

7 x 30 M006192145190 08714729766773 M006192145180 08714729777182 M006192145170 08714729766766 N/A N/A N/A N/A

8 x 20 N/A N/A N/A N/A N/A N/A N/A N/A M006192150010 08714729784814

8 x 22 M006192151190 08714729766834 M006192151180 08714729777205 N/A N/A N/A N/A M006192151010 08714729786108

8 x 24 M006192152190 08714729766865 M006192152180 08714729777212 N/A N/A N/A N/A M006192152010 08714729784807

8 x 26 M006192153190 08714729766896 M006192153180 08714729777229 M006192153170 08714729766889 M006192153050 08714729784401 M006192153010 08714729784395

8 x 28 N/A N/A M006192154180 08714729777236 N/A N/A M006192154050 08714729784418 M006192154010 08714729779513

8 x 30 M006192155190 08714729766957 M006192155180 08714729777243 N/A N/A M006192155050 08714729784425 M006192155010 08714729798866

Each Stent Supplied with Attached Braided Retrieval Line and Stent PositionerSet Includes: Polaris Ultra Dual Durometer Ureteral Stent, Stent Positioner, Axxcess™ 6Fr Ureteral Catheter, and Specified GuidewireN/A = Not AvailableApplicable Medicare C-codes: C2617 - stent, non-coronary, temporary, without delivery system; C1769 - guidewire; C1758 - catheter, ureteral



28

URETERAL STENTS


Kidney Coil(Firm Durometer Percuflex Material)

Tapered Tip

Bladder Loop Design(Soft Durometer Percuflex Material)

Polaris™ Loop Ureteral Stent Sets

FrenchSize x LengthBetweenPigtails Without Wire

.035" Sensor™ PTFE-NitinolDual-Flex Straight Tip



.035"ZIPwire


Order Number GTIN Number Order Number GTIN Number Order Number GTIN Number Order Number GTIN Number

5 x 10 M0061552110 08714729765349 N/A N/A N/A N/A N/A N/A

5 x 12 M0061552120 08714729420965 N/A N/A N/A N/A N/A N/A

5 x 14 M0061552130 08714729420972 M006155213090 08714729774808 N/A N/A N/A N/A

5 x 16 M0061552140 08714729420989 M006155214090 08714729765370 N/A N/A N/A N/A

5 x 18 M0061552150 08714729420996 M006155215090 08714729765394 M006155215120 08714729778349 N/A N/A

5 x 20 M0061552200 08714729421009 M006155220090 08714729777434 N/A N/A M006155220190 08714729778134

5 x 22 M0061552210 08714729421016 M006155221090 08714729765417 M006155221120 08714729775911 M006155221190 08714729765424

5 x 24 M0061552220 08714729421023 M006155222090 08714729765431 M006155222120 08714729782162 M006155222190 08714729765448

5 x 26 M0061552230 08714729421030 M006155223090 08714729765455 N/A N/A M006155223190 08714729765462

5 x 28 M0061552240 08714729421047 M006155224090 08714729765479 N/A N/A M006155224190 08714729765486

5 x 30 M0061552250 08714729421054 N/A N/A N/A N/A N/A N/A

6 x 20 M0061552300 08714729421061 M006155230090 08714729775652 N/A N/A M006155230190 08714729778158

6 x 22 M0061552310 08714729421078 M006155231090 08714729765493 M006155231120 08714729775508 M006155231190 08714729765509

6 x 24 M0061552320 08714729421085 M006155232090 08714729765516 M006155232120 08714729775492 M006155232190 08714729765523

6 x 26 M0061552330 08714729421092 M006155233090 08714729755432 M006155233120 08714729775522 M006155233190 08714729765530

6 x 28 M0061552340 08714729421108 M006155234090 08714729765547 M006155234120 08714729774785 M006155234190 08714729765554

6 x 30 M0061552350 08714729421115 M006155235090 08714729773771 M006155235120 08714729775546 N/A N/A

7 x 20 M0061552400 08714729421122 M006155240090 08714729777458 N/A N/A N/A N/A

7 x 22 M0061552410 08714729421139 M006155241090 08714729774037 N/A N/A M006155241190 08714729778189

7 x 24 M0061552420 08714729421146 M006155242090 08714729765561 N/A N/A M006155242190 08714729765578

7 x 26 M0061552430 08714729421153 M006155243090 08714729765585 N/A N/A M006155243190 08714729765592

7 x 28 M0061552440 08714729421160 M006155244090 08714729765608 N/A N/A M006155244190 08714729765615

7 x 30 M0061552450 08714729421177 M006155245090 08714729775607 N/A N/A M006155245190 08714729775614

8 x 20 M0061552500 08714729421184 M006155250090 08714729777465 N/A N/A N/A N/A

8 x 22 M0061552510 08714729421191 M006155251090 08714729765622 N/A N/A N/A N/A

8 x 24 M0061552520 08714729421207 M006155252090 08714729765646 N/A N/A M006155252190 08714729765653

8 x 26 M0061552530 08714729421214 M006155253090 08714729765660 N/A N/A N/A N/A

8 x 28 M0061552540 08714729421221 M006155254090 08714729765684 N/A N/A N/A N/A

8 x 30 M0061552550 08714729421238 N/A N/A N/A N/A M006155255190 08714729778202

Each Stent Supplied with Attached Braided Retrieval Line and Stent PositionerSet Includes: Polaris Loop Dual Durometer Ureteral Stent, Stent Positioner, Axxcess™ 6Fr Ureteral Catheter, and Specified GuidewireN/A = Not AvailableApplicable Medicare C-codes: C2617 - stent, non-coronary, temporary, without delivery system; C1769 - guidewire; C1758 - catheter, ureteral

(Dual Durometer Percuflex™ Material with HydroPlus™ Coating)



29

URETERAL STENTS


Polaris™ Loop Ureteral Stent Sets (Dual Durometer Percuflex™ Material with HydroPlus™ Coating) (Continued)




.038"ZIPwire™







5 x 10 N/A N/A N/A N/A N/A N/A N/A N/A





5 x 20 N/A N/A N/A N/A M006155220050 08714729788515 N/A N/A

5 x 22 M006155221180 08714729777540 M006155221170 08714729778448 M006155221050 08714729778318 N/A N/A

5 x 24 M006155222180 08714729775935 M006155222170 08714729774815 M006155222050 08714729774839 M006155222010 08714729775928

5 x 26 M006155223180 08714729777557 M006155223170 08714729774631 M006155223050 08714729775942 M006155223010 08714729788546

5 x 28 N/A N/A N/A N/A M006155224050 08714729774624 N/A N/A

5 x 30 N/A N/A N/A N/A M006155225050 08714729776154 N/A N/A

6 x 20 M006155230180 08714729777588 M006155230170 08714729788577 M006155230050 08714729782148 M006155230010 08714729775645

6 x 22 M006155231180 08714729777595 M006155231170 08714729775591 M006155231050 08714729773641 M006155231010 08714729775515

6 x 24 M006155232180 08714729774013 M006155232170 08714729775638 M006155232050 08714729755463 M006155232010 08714729774426

6 x 26 M006155233180 08714729773788 M006155233170 08714729774433 M006155233050 08714729755456 M006155233010 08714729773740

6 x 28 M006155234180 08714729774792 N/A N/A M006155234050 08714729774297 M006155234010 08714729775539

6 x 30 M006155235180 08714729777601 N/A N/A M006155235050 08714729775553 M006155235010 08714729788584

7 x 20 N/A N/A N/A N/A M006155240050 08714729788614 N/A N/A

7 x 22 N/A N/A M006155241170 08714729775430 M006155241050 08714729782124 M006155241010 08714729775409

7 x 24 M006155242180 08714729777632 M006155242170 08714729775447 M006155242050 08714729786092 M006155242010 08714729778479

7 x 26 M006155243180 08714729774686 M006155243170 08714729774938 M006155243050 08714729774488 M006155243010 08714729774518

7 x 28 M006155244180 08714729775560 N/A N/A M006155244050 08714729774716 M006155244010 08714729775621

7 x 30 M006155245180 08714729777649 N/A N/A N/A N/A M006155245010 08714729775577


8 x 22 M006155251180 08714729777663 N/A N/A N/A N/A N/A N/A

8 x 24 M006155252180 08714729777670 M006155252170 08714729776024 N/A N/A M006155252010 08714729784203

8 x 26 N/A N/A M006155253170 08714729776055 N/A N/A N/A N/A



Each Stent Supplied with Attached Braided Retrieval Line and Stent PositionerSet Includes: Polaris Loop Dual Durometer Ureteral Stent, Stent Positioner, Axxcess™ 6Fr Ureteral Catheter, and Specified GuidewireN/A = Not AvailableApplicable Medicare C-codes: C2617 - stent, non-coronary, temporary, without delivery system; C1769 - guidewire; C1758 - catheter, ureteral



30

URETERAL STENTS


Tapered Tip Large Side Ports Placement Markers

Firm Durometer Percuflex Material with HydroPlus Coating

Percuflex™ Plus Ureteral Stent Sets

French Size x Length Between Pigtails Without Wire


.038"Sensor PTFE-Nitinol



4.8 x 10 M0061751950 08714729067566 N/A N/A N/A N/A

4.8 x 12 M0061751960 08714729067580 N/A N/A N/A N/A

4.8 x 14 M0061751970 08714729067603 N/A N/A N/A N/A

4.8 x 16 M0061751980 08714729067627 M006175198090 08714729421276 N/A N/A

4.8 x 18 M0061751990 08714729067641 N/A N/A N/A N/A

4.8 x 20 M0061752500 08714729143970 M006175250090 08714729421290 N/A N/A

4.8 x 22 M0061752510 08714729067719 M006175251090 08714729421306 N/A N/A

4.8 x 24 M0061752520 08714729056805 M006175252090 08714729421313 N/A N/A

4.8 x 26 M0061752530 08714729056812 M006175253090 08714729421320 N/A N/A

4.8 x 28 M0061752540 08714729067757 M006175254090 08714729421337 N/A N/A

4.8 x 30 M0061752550 08714729067771 N/A N/A N/A N/A

6 x 20 M0061752600 08714729067788 N/A N/A N/A N/A

6 x 22 M0061752610 08714729067795 M006175261090 08714729421375 M006175261120 08714729421382

6 x 24 M0061752620 08714729056829 M006175262090 08714729421399 M006175262120 08714729421405

6 x 26 M0061752630 08714729041184 M006175263090 08714729421412 M006175263120 08714729421429

6 x 28 M0061752640 08714729041191 M006175264090 08714729421436 M006175264120 08714729421443

6 x 30 M0061752650 08714729067849 N/A N/A N/A N/A

7 x 20 M0061752700 08714729067856 N/A N/A N/A N/A

7 x 22 M0061752710 08714729067863 M006175271090 08714729421498 N/A N/A

7 x 24 M0061752720 08714729056836 M006175272090 08714729421511 N/A N/A

7 x 26 M0061752730 08714729041207 M006175273090 08714729421535 N/A N/A

7 x 28 M0061752740 08714729041214 M006175274090 08714729421559 N/A N/A

7 x 30 M0061752750 08714729056843 N/A N/A N/A N/A

8 x 20 M0061752800 08714729067917 N/A N/A N/A N/A

8 x 22 M0061752810 08714729067924 N/A N/A M006175281120 08714729421627

8 x 24 M0061752820 08714729056850 M006175282090 08714729421634 N/A N/A

8 x 26 M0061752830 08714729041221 N/A N/A N/A N/A

8 x 28 M0061752840 08714729067931 N/A N/A N/A N/A

8 x 30 M0061752850 08714729067948 N/A N/A N/A N/A

Each Stent Supplied with Attached Retrieval Line and Stent Positioner, and Pigtail Straightener where applicable.Set Includes: Percuflex Plus Stent with HydroPlus Coating, Axxcess™ 6Fr Ureteral Catheter and Specified Guidewire8Fr Stents supplied with micro stabilizer stent positioner4.8Fr Stents supplied with braided retrieval line. 6Fr, 7Fr, and 8Fr stents supplied with monofilament retrieval lineN/A = Not AvailableApplicable Medicare C-codes: C2617 - stent, non-coronary, temporary, without delivery system; C1769 - guidewire; C1758 - catheter, ureteral

(with HydroPlus™ Coating)



31

URETERAL STENTS


Percuflex™ Plus Ureteral Stent Sets (with HydroPlus™ Coating) (Continued)


.035" ZIPwire™




.038" ZIPwire



4.8 x 10 M006175195190 08714729765707 M006175195180 08714729776918 N/A N/A

4.8 x 12 M006175196190 08714729765714 M006175196180 08714729776178 N/A N/A

4.8 x 14 M006175197190 08714729765721 M006175197180 08714729776925 N/A N/A

4.8 x 16 M006175198190 08714729776185 M006175198180 08714729774600 N/A N/A

4.8 x 18 M006175199190 08714729774846 M006175199180 08714729774853 N/A N/A

4.8 x 20 M006175250190 08714729776161 M006175250180 08714729774280 N/A N/A

4.8 x 22 M006175251190 087147297742 11 M006175251180 08714729776130 N/A N/A

4.8 x 24 M006175252190 08714729765738 M006175252180 08714729773139 N/A N/A

4.8 x 26 M006175253190 08714729765745 M006175253180 08714729772736 N/A N/A

4.8 x 28 M006175254190 08714729773535 M006175254180 08714729772941 N/A N/A

4.8 x 30 M006175255190 08714729773801 M006175255180 08714729776093 N/A N/A

6 x 20 M006175260190 08714729774693 M006175260180 08714729776109 M006175260170 08714729773429

6 x 22 M006175261190 08714729776147 M006175261180 08714729773665 M006175261170 08714729765752

6 x 24 M006175262190 08714729773702 M006175262180 08714729772835 M006175262170 08714729764748

6 x 26 M006175263190 08714729772996 M006175263180 08714729767848 M006175263170 08714729762706

6 x 28 M006175264190 08714729774112 M006175264180 08714729772750 M006175264170 08714729765769

6 x 30 M006175265190 08714729776017 M006175265180 08714729772811 M006175265170 08714729774709

7 x 20 N/A N/A M006175270180 08714729776932 M006175270170 08714729774860

7 x 22 M006175271190 08714729775980 M006175271180 08714729774228 M006175271170 08714729773900

7 x 24 M006175272190 08714729767831 M006175272180 08714729772958 M006175272170 08714729765776

7 x 26 M006175273190 08714729773177 M006175273180 08714729772767 M006175273170 08714729764700

7 x 28 M006175274190 08714729773207 M006175274180 08714729772774 M006175274170 08714729773344

7 x 30 M006175275190 08714729774648 M006175275180 08714729772965 N/A N/A

8 x 20 M006175280190 08714729775997 N/A N/A M006175280170 08714729774129

8 x 22 N/A N/A M006175281180 08714729776956 M006175281170 08714729773917

8 x 24 M006175282190 08714729776352 M006175282180 08714729774778 M006175282170 08714729765783

8 x 26 M006175283190 08714729774945 M006175283180 08714729773450 M006175283170 08714729774303

8 x 28 M006175284190 08714729774952 M006175284180 08714729773290 M006175284170 08714729765790

8 x 30 N/A N/A M006175285180 08714729773368 M006175285170 08714729773610

Set Includes: Percuflex Plus Stent with HydroPlus Coating and attached Retrieval Line, Stent Positioner, Axxcess™ 6Fr Ureteral Catheter and Specified Guidewire8Fr Stents supplied with micro stabilizer stent positioner4.8Fr Stents supplied with braided retrieval line. 6Fr, 7Fr, and 8Fr stents supplied with monofilament retrieval lineN/A = Not AvailableApplicable Medicare C-codes: C2617 - stent, non-coronary, temporary, without delivery system; C1769 - guidewire; C1758 - catheter, ureteral



32

URETERAL STENTS


Percuflex™ Plus Ureteral Stent Sets (with HydroPlus™ Coating) (Continued)






Without GuidewireWith Braided Retrieval Line


4.8 x 10 M006175195050 08714729285465 N/A N/A N/A N/A

4.8 x 12 M006175196050 08714729285472 N/A N/A N/A N/A

4.8 x 14 M006175197050 08714729297246 N/A N/A N/A N/A

4.8 x 16 M006175198050 08714729297260 N/A N/A N/A N/A

4.8 x 18 M006175199050 08714729297284 N/A N/A N/A N/A

4.8 x 20 M006175250050 08714729339946 N/A N/A N/A N/A

4.8 x 22 M006175251050 08714729339953 N/A N/A M0061755510 08714729421726

4.8 x 24 M006175252050 08714729339960 N/A N/A M0061755520 08714729421801

4.8 x 26 M006175253050 08714729339977 N/A N/A M0061755530 08714729421887

4.8 x 28 M006175254050 08714729170082 N/A N/A M0061755540 08714729421962

4.8 x 30 M006175255050 08714729339984 N/A N/A N/A N/A

6 x 20 N/A N/A M006175260010 08714729268857 M0061755600 08714729422044

6 x 22 M006175261050 08714729460725 M006175261010 08714729339991 M0061755610 08714729422167

6 x 24 M006175262050 08714729460794 M006175262010 08714729340003 M0061755620 08714729422280

6 x 26 M006175263050 08714729460862 M006175263010 08714729302032 M0061755630 08714729422402

6 x 28 M006175264050 08714729460930 M006175264010 08714729302063 M0061755640 08714729422518

6 x 30 M006175265050 08714729461005 M006175265010 08714729302070 M0061755650 08714729340089

7 x 20 N/A N/A M006175270010 08714729302087 N/A N/A

7 x 22 M006175271050 08714729461159 M006175271010 08714729268864 M0061755710 08714729422730

7 x 24 M006175272050 08714729461227 M006175272010 08714729340034 M0061755720 08714729422853

7 x 26 M006175273050 08714729461296 M006175273010 08714729340041 M0061755730 08714729422976

7 x 28 M006175274050 08714729461364 M006175274010 08714729340058 M0061755740 08714729423096

7 x 30 N/A N/A M006175275010 08714729302094 N/A N/A

8 x 20 N/A N/A M006175280010 08714729268871 N/A N/A

8 x 22 N/A N/A M006175281010 08714729268888 M0061755810 08714729423232

8 x 24 N/A N/A M006175282010 08714729302100 M0061755820 08714729423355

8 x 26 N/A N/A M006175283010 08714729302117 M0061755830 08714729423461

8 x 28 N/A N/A M006175284010 08714729340065 M0061755840 08714729423584

8 x 30 N/A N/A M006175285010 08714729268895 N/A N/A

N/A = Not Available



33

URETERAL STENTS


Tapered Tip

Firm Durometer Percuflex Material

Large Side Ports

Placement Marker

Percuflex™ Ureteral Stents


WithoutGuidewire

.035"ZIPwire™


.038" ZIPwire






Order Number GTIN Number Order Number GTIN Number Order Number GTIN Number Order Number GTIN Number Order Number GTIN Number

4.8 x 22

M0061453500 08714729040255 M006145350190 08714729788058 N/A N/A M006145350050 08714729297055 N/A N/A

4.8 x 24

M0061453510 08714729040262 N/A N/A N/A N/A M006145351050 08714729339748 N/A N/A

4.8 x 26

M0061453520 08714729040279 M006145352190 08714729775812 N/A N/A M006145352050 08714729339755 N/A N/A

4.8 x 28

M0061453530 08714729040286 M006145353190 08714729779384 N/A N/A M006145353050 08714729297062 N/A N/A

6 x 20 M0061453590 08714729040309 N/A N/A N/A N/A N/A N/A M006145359010 08714729297086

6 x 22 M0061453600 08714729040316 N/A N/A N/A N/A N/A N/A N/A N/A

6 x 24 M0061453610 08714729040323 M006145361190 08714729775966 M006145361170 08714729775836 M006145361050 08714729458012 M006145361010 08714729339779

6 x 26 M0061453620 08714729040330 M006145362190 08714729775843 M006145362170 08714729775898 M006145362050 08714729458104 M006145362010 08714729339786

6 x 28 M0061453630 08714729040347 M006145363190 08714729775850 M006145363170 08714729775805 M006145363050 08714729458197 M006145363010 08714729339793

6 x 30 M0061453640 08714729040354 M006145364190 08714729777809 N/A N/A N/A N/A M006145364010 08714729297093

7 x 20 M0061453690 08714729040361 N/A N/A M006145369170 08714729788171 N/A N/A M006145369010 08714729297109

7 x 22 M0061453700 08714729040378 N/A N/A N/A N/A M006145370050 08714729458470 M006145370010 08714729297116

7 x 24 M0061453710 08714729040385 N/A N/A N/A N/A M006145371050 08714729458562 M006145371010 08714729339809

7 x 26 M0061453720 08714729040392 N/A N/A N/A N/A M006145372050 08714729458654 M006145372010 08714729339816

7 x 28 M0061453730 08714729040408 N/A N/A N/A N/A M006145373050 08714729458746 M006145373010 08714729339823

7 x 30 M0061453740 08714729040415 N/A N/A N/A N/A M006145374050 08714729458838 M006145374010 08714729297123

8 x 20 M0061453790 08714729040422 N/A N/A N/A N/A N/A N/A N/A N/A




8 x 28 M0061453830 08714729040460 N/A N/A N/A N/A M006145383050 08714729459286 M006145383010 08714729301967


Each Stent Supplied with Attached Retrieval Line and Stent Positioner, and Pigtail Straightener where applicable.Set Includes: Percuflex Stent, Axxcess™ 6Fr Ureteral Catheter and Specified Guidewire8Fr Stents supplied with micro stabilizer stent positionerN/A = Not AvailableApplicable Medicare C-codes: C2617 - stent, non-coronary, temporary, without delivery system; C1769 - guidewire; C1758 - catheter, ureteral



34

URETERAL STENTS


Soft Durometer Percuflex Material with HydroPlus Coating

Tapered TipLarge Side Ports

Placement Markers

Contour™ Ureteral Stent Sets

FrenchSize x LengthBetweenPigtails Without Guidewire

Without GuidewireWith Braided Retrieval Line



6 x 20 M0061802200 08714729058441 M0061805200 08714729285496 M006180220090 08714729423942

6 x 22 M0061802210 08714729058472 M0061805210 08714729285502 M006180221090 08714729423980

6 x 24 M0061802220 08714729058502 M0061805220 08714729285519 M006180222090 08714729424024

6 x 26 M0061802230 08714729058533 M0061805230 08714729285526 M006180223090 08714729424062

6 x 28 M0061802240 08714729058564 M0061805240 08714729285533 M006180224090 08714729424109

6 x 30 M0061802250 08714729058595 M0061805250 08714729285540 M006180225090 08714729424147

7 x 20 M0061802300 08714729058625 N/A N/A N/A N/A

7 x 22 M0061802310 08714729058656 M0061805310 08714729285557 N/A N/A

7 x 24 M0061802320 08714729058687 M0061805320 08714729285564 M006180232090 08714729424260

7 x 26 M0061802330 08714729058717 M0061805330 08714729285571 M006180233090 08714729424307

7 x 28 M0061802340 08714729058731 M0061805340 08714729285588 M006180234090 08714729424345

7 x 30 M0061802350 08714729058762 N/A N/A N/A N/A

8 x 20 M0061802400 08714729058793 N/A N/A N/A N/A

8 x 22 M0061802410 08714729058823 N/A N/A N/A N/A

8 x 24 M0061802420 08714729058854 M0061805420 08714729285625 N/A N/A

8 x 26 M0061802430 08714729058885 M0061805430 08714729425977 N/A N/A

8 x 28 M0061802440 08714729058915 N/A N/A N/A N/A

8 x 30 M0061802450 08714729058946 N/A N/A N/A N/A

4.8 x 22-30 M0061801550 08714729058410 N/A N/A M006180155090 08714729423768

6 x 22-30 M0061801560 08714729067986 N/A N/A M006180156090 08714729423829

7 x 22-30 M0061801570 08714729068020 N/A N/A N/A N/A

Each Stent Supplied with Attached Retrieval Line and Stent Positioner, and Pigtail Straightener where applicable.Set Includes: Contour Stent with HydroPlus Coating, Axxcess™ 6Fr Ureteral Catheter and Specified Guidewire8Fr Stents Supplied with Positioner AssemblyN/A = Not AvailableApplicable Medicare C-codes: C2617 - stent, non-coronary, temporary, without delivery system; C1769 - guidewire; C1758 - catheter, ureteral

(with HydroPlus™ Coating) – A Softer Percuflex™ Material Stent



35

URETERAL STENTS


Contour™ Ureteral Stent Sets (with HydroPlus™ Coating) – A Softer Percuflex™ Material Stent (Continued)




.035" ShaftZIPwire™





6 x 20 M006180220120 08714729423966 M006180220190 08714729776581 N/A N/A

6 x 22 M006180221120 08714729424000 M006180221190 08714729779315 M006180221180 08714729777908

6 x 24 M006180222120 08714729424048 M006180222190 08714729781066 M006180222180 08714729773030

6 x 26 M006180223120 08714729424086 M006180223190 08714729773658 M006180223180 08714729772729

6 x 28 M006180224120 08714729424123 M006180224190 08714729776611 M006180224180 08714729772828

6 x 30 N/A N/A N/A N/A M006180225180 08714729773979

7 x 20 N/A N/A M006180230190 08714729776574 N/A N/A

7 x 22 M006180231120 08714729424246 M006180231190 08714729777755 M006180231180 08714729776703

7 x 24 M006180232120 08714729424284 M006180232190 08714729777762 M006180232180 08714729774105

7 x 26 M006180233120 08714729424321 M006180233190 08714729774556 M006180233180 08714729772804

7 x 28 M006180234120 08714729424369 M006180234190 08714729774907 M006180234180 08714729772934

7 x 30 N/A N/A N/A N/A M006180235180 08714729776291

8 x 20 N/A N/A N/A N/A N/A N/A

8 x 22 N/A N/A M006180241190 08714729779377 M006180241180 08714729776383

8 x 24 N/A N/A M006180242190 08714729781080 M006180242180 08714729774822

8 x 26 N/A N/A M006180243190 08714729774617 M006180243180 08714729773191

8 x 28 N/A N/A M006180244190 08714729789215 M006180244180 08714729774471


4.8 x 22-30 N/A N/A M006180155190 08714729765813 M006180155180 08714729772866

6 x 22-30 N/A N/A M006180156190 08714729765837 M006180156180 08714729772743

7 x 22-30 N/A N/A M006180157190 08714729765851 M006180157180 08714729772989

Set Includes: Contour Stent with HydroPlus Coating and Attached Retrieval Line, Stent Positioner, Axxcess™ 6Fr Ureteral Catheter and Specified Guidewire8Fr Stents supplied with micro stabilizer stent positionerN/A = Not AvailableApplicable Medicare C-codes: C2617 - stent, non-coronary, temporary, without delivery system; C1769 - guidewire; C1758 - catheter, ureteral



36

URETERAL STENTS


Contour™ Ureteral Stent Sets (with HydroPlus™ Coating) – A Softer Percuflex™ Material Stent (Continued)


.038" ZIPwire







6 x 20 N/A N/A M006180220050 08714729462040 M006180220010 08714729058458

6 x 22 M006180221170 08714729765868 M006180221050 08714729462118 M006180221010 08714729058489

6 x 24 M006180222170 08714729764731 M006180222050 08714729462187 M006180222010 08714729058519

6 x 26 M006180223170 08714729764724 M006180223050 08714729462248 M006180223010 08714729058540

6 x 28 M006180224170 08714729773238 M006180224050 08714729462309 M006180224010 08714729058571

6 x 30 M006180225170 08714729764717 M006180225050 08714729462378 M006180225010 08714729058601

7 x 20 N/A N/A M006180230050 08714729462446 N/A N/A

7 x 22 M006180231170 08714729773863 M006180231050 08714729462514 M006180231010 08714729058663

7 x 24 M006180232170 08714729773405 M006180232050 08714729462583 M006180232010 08714729058694

7 x 26 M006180233170 08714729773160 N/A N/A M006180233010 08714729058724

7 x 28 M006180234170 08714729773757 N/A N/A M006180234010 08714729058748

7 x 30 N/A N/A M006180235050 08714729462798 M006180235010 08714729058779

8 x 20 M006180240170 08714729776376 N/A N/A N/A N/A

8 x 22 M006180241170 08714729773504 N/A N/A M006180241010 08714729058830

8 x 24 M006180242170 08714729774099 N/A N/A M006180242010 08714729058861

8 x 26 M006180243170 08714729773818 N/A N/A M006180243010 08714729058892

8 x 28 M006180244170 08714729776604 N/A N/A M006180244010 08714729058922


4.8 x 22-30 M006180155170* 08714729765806 M006180155050 08714729423720 M006180155010* 08714729058427*

6 x 22-30 M006180156170 08714729765820 M006180156050 08714729423782 M006180156010 08714729067993

7 x 22-30 M006180157170 08714729765844 M006180157050 08714729423867 M006180157010 08714729058434

Each Stent Supplied with Attached Retrieval Line and Stent Positioner, and Pigtail Straightener where applicable.Set Includes: Contour Stent with HydroPlus Coating, Axxcess™ 6Fr Ureteral Catheter and Specified Guidewire8Fr Stents supplied with micro stabilizer stent positionerN/A = Not AvailableApplicable Medicare C-codes: C2617 - stent, non-coronary, temporary, without delivery system; C1769 - guidewire; C1758 - catheter, ureteral



37

URETERAL STENTS


Contour™ Injection Stent Sets

French Size x Length BetweenPigtails

.035" PTFE

Coated Straight Tip

.038" PTFE

Coated Straight Tip

Order Number GTIN Number Order Number GTIN Number

4.8 x 24 M0061856070 08714729340560 N/A N/A

4.8 x 26 M0061856080 08714729340577 N/A N/A

4.8 x 28 M0061856090 08714729340584 N/A N/A

6 x 22 N/A N/A M0061856120 08714729346142

6 x 24 N/A N/A M0061856130 08714729346159

6 x 26 N/A N/A M0061856140 08714729346166

6 x 28 N/A N/A M0061856150 08714729346173

6 x 30 N/A N/A M0061856160 08714729346180

7 x 20 N/A N/A M0061856170 08714729346197

7 x 22 N/A N/A M0061856180 08714729340676

7 x 24 N/A N/A M0061856190 08714729340683

7 x 26 N/A N/A M0061856200 08714729340690

7 x 28 N/A N/A M0061856210 08714729340706

7 x 30 N/A N/A M0061856220 08714729340713

4.8 x 22-30 M0061856290 08714729340782 N/A N/A

6 x 22-30 N/A N/A M0061856300 08714729340799

7 x 22-30 N/A N/A M0061856310 08714729340805

Each Stent Set Supplied with Attached Retrieval, PTFE Guidewire, Injection Positioner and Released Sleeve with Injection Hub.N/A = Not AvailableApplicable Medicare C-codes: C2617 - stent, non-coronary, temporary, without delivery system; C1769 - guidewire

(Percuflex™ Material with HydroPlus™ Coating) Guidewire Supplied



38

URETERAL STENTS


Placement Marker

Retrieval Line

Mardis Soft Ureteral Stent Sets


.035" Lubriglide™

Coated Guidewire

.038" Lubriglide

Coated Guidewire

.038" ZIPwire™





4.8 x 10 M0061251150 08714729065715 N/A N/A N/A N/A N/A N/A

4.8 x 12 M0061251160 08714729178224 N/A N/A N/A N/A N/A N/A

4.8 x 14 M0061251170 08714729178217 N/A N/A N/A N/A N/A N/A

4.8 x 16 M0061251180 08714729065746 N/A N/A N/A N/A N/A N/A

4.8 x 18 M0061251190 08714729065753 N/A N/A N/A N/A N/A N/A

4.8 x 22 M0061251210 08714729047728 N/A N/A N/A N/A N/A N/A

4.8 x 24 M0061251220 08714729047735 N/A N/A N/A N/A N/A N/A

4.8 x 26 M0061251230 08714729047742 N/A N/A N/A N/A N/A N/A

4.8 x 28 M0061251240 08714729037859 N/A N/A N/A N/A N/A N/A

6 x 20 N/A N/A M0061251300 08714729037873 N/A N/A N/A N/A

6 x 22 N/A N/A M0061251310 08714729037880 M0061265310 08714729757634 M0061265710 08714729757771

6 x 24 N/A N/A M0061251320 08714729047759 M0061265320 08714729756835 M0061265720 08714729757689

6 x 26 N/A N/A M0061251330 08714729047766 M0061265330 08714729756842 M0061265730 08714729757696

6 x 28 N/A N/A M0061251340 08714729047773 M0061265340 08714729757641 M0061265740 08714729757702

6 x 30 N/A N/A M0061251350 08714729037927 N/A N/A N/A N/A

7 x 20 N/A N/A M0061251400 08714729037934 N/A N/A N/A N/A

7 x 22 N/A N/A M0061251410 08714729178361 N/A N/A N/A N/A

7 x 24 N/A N/A M0061251420 08714729047780 N/A N/A N/A N/A

7 x 26 N/A N/A M0061251430 08714729047797 N/A N/A N/A N/A

7 x 28 N/A N/A M0061251440 08714729047803 M0061265440 08714729757658 M0061265840 08714729757733

7 x 30 N/A N/A M0061251450 08714729056768 M0061265450 08714729757665 M0061265850 08714729757740

8 x 20 N/A N/A M0061251500 08714729037996 N/A N/A N/A N/A

8 x 22 N/A N/A M0061251510 08714729038009 N/A N/A N/A N/A

8 x 24 N/A N/A M0061251520 08714729038016 N/A N/A N/A N/A

8 x 26 N/A N/A M0061251530 08714729047810 M0061265530 08714729756828 M0061265930 08714729757757

8 x 28 N/A N/A M0061251540 08714729047827 M0061265540 08714729757672 M0061265940 08714729757764

Set Includes: Mardis Soft Stent with HydroPlus Coating with Attached Retrieval Line (except for 4.8Fr size), Stent Positioner, Specified Guidewire, Axxcess™ 6Fr Ureteral CatheterN/A = Not AvailableApplicable Medicare C-codes: C2617 - stent, non-coronary, temporary, without delivery system; C1769 - guidewire; C1758 - catheter, ureteral




39

URETERAL STENTS


Placement Markers

Retrieval Line

NautilusTM Bladder Coil

Stretch™ VL Flexima™ Ureteral Stent Sets


WithoutGuidewire

.035" Stiff ShaftZIPwire™





4.8 x 22-30 M0061851550 08714729160786 M006185155180 08714729777250 N/A N/A

6 x 22-30 M0061851560 08714729160809 N/A N/A M006185156010 08714729160816

7 x 22-30 M0061851570 08714729160823 N/A N/A M006185157010 08714729160830

Each Stent Supplied with Attached Retrieval Line and Stent PositionerSet Includes: Stretch VL Stent, Specified Guidewire, Axxcess™ 6Fr Ureteral CatheterN/A = Not AvailableApplicable Medicare C-codes: C2617 - stent, non-coronary, temporary, without delivery system; C1769 - guidewire; C1758 - catheter, ureteral

Stretch VL Flexima Ureteral Stent Sets


.035"ZIPwire


.035" PTFE


.035" Sensor™ PTFE-Nitinol

5cm Straight Tip


4.8 x 22-30 M006185155190 08714729776253 M006185155050 08714729297727 M006185155080 08714729297734

6 x 22-30 M006185156190 08714729778097 N/A N/A M006185156080 08714729297741

7 x 22-30 M006185157190 08714729778103 N/A N/A M006185157080 08714729297765

Set Includes: Stretch VL Stent with Attached Retrieval Line, Stent Positioner, Specified Guidewire, Axxcess 6Fr Ureteral CatheterN/A = Not AvailableApplicable Medicare C-codes: C2617 - stent, non-coronary, temporary, without delivery system; C1769 - guidewire; C1758 - catheter, ureteral





40

URETERAL STENTS

URETERAL STENTS AND SETS

7Fr Distal Diameter

14Fr ProximalDiameter

Retromax™ Plus Endopyelotomy Stents

Order Number GTIN NumberTaper Size From/To

(Fr)Length Between Pigtails

(cm) Unit

M0061451470 08714729170549 14/7 22 ea

M0061451480 08714729171546 14/7 24 ea

M0061451490 08714729171553 14/7 26 ea

M0061451500 08714729171560 14/7 28 ea

M0061451510 08714729171577 14/7 30 ea

Each Stent Supplied with Metal Tip Stent PositionerApplicable Medicare C-codes: C2617 - stent, non-coronary, temporary, without delivery system

Large Side Ports

Detachable Hub

Percuflex™ Urinary Diversion Stent Sets

Order Number GTIN Number French SizeUsable Length

(cm)Tip

Configuration Unit

M0061602050 08714729297161 6 80 Open Tip ea

M0061602100 08714729297178 7 80 Open Tip ea

M0061602150 08714729297185 8 80 Open Tip ea

M0061602250 08714729297192 6 80 Closed Tip ea

M0061602300 08714729297208 7 80 Closed Tip ea

M0061602350 08714729297215 8 80 Closed Tip ea

Set Includes: (2) Percuflex Urinary Diversion Stents, (1) .038" Stiff Bodied PTFE Coated Guidewire, (2) Color-Coded Catheter Adaptors and (2) Drainage Bag ConnectorsApplicable Medicare C-codes: C2617 - stent, non-coronary, temporary, without delivery system; C1769 - guidewire



41

URETERAL STENTS

STENT ACCESSORIES

Radiopaque Marker

Ureteral Stent Positioners

Order Number GTIN Number French SizeLength

(cm) Unit

M0061802001 08714729462026 4.8 45 bx 10

M0061802011 08714729041245 6 45 bx 10

M0061802021 08714729041252 7 45 bx 10

M0061802031 08714729041269 8 45 bx 10

Radiopaque Marker on All Sizes Except the 4.8Fr Ureteral Stent PositionerApplicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.#10



42

NOTES

UR

ETERA

LCATH

ETERS



UR

ETER

AL

CATH

ETER

S




43

TORQUEABLE CATHETERSGreen Guidewire Lumen .038"

Yellow Injection Lumen .050"

.038" Guidewire

Dual Lumen Ureteral Catheter


(Fr)Working Length

(cm)Recommended Guidewire (in)

InjectionLumen (in) Unit

M0064051000 08714729012689 10 54 .038 .050 ea


Order Number GTIN Number DescriptionO.D. Size

(Fr)Working Length

(cm) Unit

M0064003001 08714729430261 C1 5 65 bx 5

M0064003011 08714729430278 C2 5 65 bx 5

M0064003021 08714729430285 Straight 5 65 bx 5

M0064003031 08714729430292 Bern 5 65 bx 5

M0064003041 08714729430308 JB1 5 65 bx 5

M0064004021 08714729430315 Straight 5 100 bx 5

M0064004031 08714729430322 Bern 5 100 bx 5

M0064004041 08714729430339 JB1 5 100 bx 5

M0064005031 08714729430346 Bern 5 40 bx 5

Applicable Medicare C-codes: C1758 - catheter, ureteral

URETERAL CATHETERS



44

URETERAL CATHETERS

TORQUEABLE CATHETERS (Continued)

Ureteral Catheters: Open End Ureteral Catheters

Order Number GTIN Number DescriptionCatheter O.D. Size

(Fr)Working Length

(cm)Tip O.D. Size

(Fr) Unit

M0064002001 08714729342076 Open Tip 4 70 - bx 20

M0064002011 08714729342083 Open Tip 5 70 - bx 20

M0064002021 08714729342090 Open Tip 6 70 - bx 20

M0064002031 08714729342106 Open Tip 7 70 - bx 20

M0064002041 08714729342113 Open Tip 8 70 - bx 20

M0064002111 08714729342168 Cone Tip 5 70 8 bx 20

M0064002121 08714729342175 Cone Tip 6 70 10 bx 20

M0064002131 08714729342182 Cone Tip 7 70 12 bx 20

M0064002141 08714729342199 Cone Tip 8 70 14 bx 20

M0064002301 08714729302506 Olive Tip 4 70 - bx 20

M0064002311 08714729302513 Olive Tip 5 70 - bx 20

M0064002361 08714729268918 Spiral Tip 5 70 - bx 20

M0064002371 08714729268925 Spiral Tip 6 70 - bx 20

M0064002411 08714729302544 Wedge Tip 5 70 14 bx 20

Each Catheter Supplied with Injection HubApplicable Medicare C-codes: C1758 - catheter, ureteral

Ureteral Catheters: Angled Tip Ureteral Catheters

Order Number GTIN Number DescriptionCatheter O.D. Size

(Fr)Working Length

(cm)Tip O.D. Size

(Fr) Unit

M0064002510 08714729256830 Angled Tip Set 5 70 - ea

M0064002520 08714729256847 Angled Tip Set 6 70 - ea

Set Includes: Angled Tip Catheter, .035" PTFE Bentson Tip Guidewire and Injection HubApplicable Medicare C-codes: C1758 - catheter, ureteral

(Sets with .035" PTFE Bentson Tip Guidewire)



45

URETERAL CATHETERS


Lock

Axxcess™ Catheter: Open End Ureteral Catheter

Order Number GTIN NumberCatheter O.D. Size

(Fr)Working Length

(cm) Unit

M0064001161 08714729191971 6 70 bx 10


C-Flex™ Ureteral Catheters: Flexible Tip Open End Ureteral Catheter Sets


(Fr)Working Length

(cm) Unit

M0064001400 08714729011088 6 70 ea

M0064001410 08714729011071 7 70 ea

Set Includes: C-Flex Flexible Tip Catheter, .038" Stainless Steel Guidewire and (2) Luer Lock Catheter AdaptorsApplicable Medicare C-codes: C1758 - catheter, ureteral



46

URETERAL CATHETERS


C-Flex™ Ureteral Catheters: Open End Ureteral Catheter Sets


(Fr)Working Length

(cm) Unit

M0064001500 08714729005162 4.8 70 ea

M0064001510 08714729005179 6 70 ea

M0064001520 08714729700517 7 70 ea

M0064001530 08714729005193 8 70 ea

Set Includes: Firm C-Flex Catheter, .038" Stainless Steel Guidewire and Two (2) Luer Lock Catheter AdaptorsApplicable Medicare C-codes: C1758 - catheter, ureteral

C-Flex Ureteral Catheters: Pigtail Ureteral Catheter Sets


(Fr)Increments of Side Ports

(cm)Working Length

(cm) Unit

M0064001700* 08714729011224 4.8 5 70 ea

M0064001710 08714729011231 6 5 70 ea

M0064001720 08714729011248 7 5 70 ea

M0064001730 08714729011255 8 5 70 ea

*Set Includes: Firm C-Flex Pigtail Catheter, .038" Lubriglide™ Coated Guidewire and Two (2) Luer Lock Catheter Adaptors Set Includes: Firm C-Flex Pigtail Catheter, .038" PTFE Coated Guidewire and Two (2) Luer Lock Catheter Adaptors Applicable Medicare C-codes: C1758 - catheter, ureteral



47

NOTES


48

NOTES

NEPH

ROSTOMY

PRODUCTS



NEP

HRO

STOM

YPR

ODU

CTS




49


PERCUTANEOUS KITS

Lingeman Percutaneous Tract Kit with ZIPwire™ Guidewire containsL AT E X


M0064501150 08714729789536 Lingeman Percutaneous Tract Kit with Zipwire Guidewire ea

Kit Includes: .035in x 150cm x Straight Tip ZIPwire Guidewire, .035in x 150cm x “J” Tip PTFE Coated Moveable Core Guidewire, .035in x 150cm x Straight Tip PTFE Coated Moveable Core Guidewire, .035in x 145cm x Straight Tip Amplatz Super Stiff™ PTFE Coated Guidewire, 7F Occluder™ Occlusion Balloon Catheter, 18ga x 20cm Percutaneous Access Needle, 8/10 Dilator/Sheath Set, 8F Amplatz Type Renal Dilator, NephroMax™ Nephrostomy Balloon Catheter Kit (Kit Includes: NephroMax High Pressure Nephrostomy Balloon Catheter, 30F ID Amplatz Type Renal Sheath, High Pressure Stopcock, 20ml Encore™ 26 Inflator with Pressure Gauge), UroLok™ II Scope Adaptor, 20F Re-Entry™ Malecot Nephrostomy Catheter SetApplicable Medicare C-codes: C1769 - guidewire; C2628 - catheter, occlusion; C1726 - catheter, balloon dilatation, non-vascular; C1729 - catheter, drainage

Percutaneous Tract Kit with ZIPwire Guidewire containsL AT E X


M0064501140 08714729784432 Percutaneous Tract Kit with Zipwire Guidewire ea

Kit Includes: .038in x 150cm x Straight Tip ZIPwire Guidewire, .038in x 150cm x Straight Tip Stiff Bodied PTFE Coated Guidewire, .038in x 150cm x Angled Tip Zebra™ Guidewire, .038in x 145cm x “J” Tip Amplatz Super Stiff PTFE Coated Guidewire, 7F Occluder Occlusion Balloon Catheter, 18ga x 20cm Percutaneous Access Needle, 8/10 Dilator/Sheath Set, 8F Amplatz Type Renal Dilator, NephroMax Nephrostomy Balloon Catheter Kit (Kit Includes: NephroMax High Pressure Nephrostomy Balloon Catheter, 30F ID Amplatz Type Renal Sheath, High Pressure Stopcock, 20ml Encore 26 Inflator with Pressure Gauge), 24F Re-Entry Malecot Nephrostomy Catheter Set Applicable Medicare C-codes: C1769 - guidewire; C2628 - catheter, occlusion; C1726 - catheter, balloon dilatation, non-vascular; C1729 - catheter, drainage

Percutaneous Access Set


M0064201100 08714729012702 Percutaneous Access Set ea

Kit Includes: 21ga Trocar Point Needle, 19ga Trocar Point Needle with 5F PTFE Sheath, Six Fascial Dilators (6F-16F Even French sizes), Catheter Retention Device, .038in x 150cm x “J” Tip Stiff Bodied PTFE Coated Guidewire, Connecting Tube With Removable Stopcock, #11 Disposable ScalpelApplicable Medicare C-codes: C1769 - guidewire

Percutaneous Access Sets – Pigtail Catheter


(Fr)Working Length

(cm) Unit

M0064201110 08714729009733 8 30 ea

M0064201120* 08714729009740 10 30 ea

Kit Includes: C-Flex™ Pigtail Catheter, 21ga Trocar Point Needle, 19ga Trocar Point Needle with 5F PTFE Sheath, Fascial Dilators (6F-10F Even Sizes), Catheter Retention Device, .038in x 150cm x “J” Tip Stiff Bodied PTFE Coated Guidewire, Connecting Tube With Removable Stopcock, #11 Disposable Scalpel*Also Includes: 12Fr Fascial DilatorApplicable Medicare C-codes: C1729 - catheter, drainage; C1769 - guidewire



50


INTRODUCER SETS

NaviGuide™ Percutaneous Access Needle

Order Number GTIN Number Description Gauge Length (cm) Unit

M0067001310 08714729953364 NaviGuide Percutaneous Access Needle 18 12 ea




TLA Introducer Needle and Sheath Set

Order Number GTIN Number Description Gauge Length (cm) Unit

M0067001200 08714729005209 TLA Introducer Needle and Sheath Set 19 20 ea


BALLOON DILATION CATHETERS

NephroMax™ High Pressure Nephrostomy Balloon Catheters


BalloonInflated O.D.

BalloonLength

(cm)


(cm)

Sheath Type

Unit(Fr) (mm) (Fr) (mm) (Fr) (cm)

M0062101170 08714729012641 30 10 12 7 2.3 55 30 17 PTFE ea

M0062101400 08714729826484 24 8 12 7 2.3 55 24 17 PTFE ea

M0062101420 08714729826491 30 10 12 7 2.3 55 30 17 Clear ea

M0062101440 08714729826507 30 10 15 7 2.3 55 30 20 PTFE ea

Supplied With: High Pressure Stopcock and Renal SheathApplicable Medicare C-codes: C1726 - catheter, balloon dilatation, non-vascular

NephroMax High Pressure Nephrostomy Balloon Catheters (Kits)


BalloonInflated O.D.

BalloonLength

(cm)


(cm)

Sheath Type

Unit(Fr) (mm) (Fr) (mm) (Fr) (cm)

M0062101180 08714729077589 30 10 12 7 2.3 55 30 17 PTFE ea

M0062101600 08714729834540 24 8 12 7 2.3 55 24 17 PTFE ea

M0062101620 08714729834526 30 10 12 7 2.3 55 30 17 Clear ea

M0062101640 08714729834533 30 10 15 7 2.3 55 30 20 PTFE ea

Kit Includes: NephroMax High Pressure Nephrostomy Balloon Catheter, Renal Sheath, High Pressure Stopcock and 20ml Encore 26 Inflator with Pressure GaugeApplicable Medicare C-codes: C1726 - catheter, balloon dilatation, non-vascular



51


INFLATION DEVICES



M0067101131 08714729761815 20ml Encore 26 Inflator with Pressure Gauge bx 5

M0067101140 08714729755814 20ml Encore 26 Inflator with Pressure Gauge ea


DILATORS AND SHEATHS

Clear Renal Sheath


O.D. Size I.D. Size Total Length(cm) Unit(Fr) (mm) (Fr) (mm)

M0062601600 08714729341727 34 11.3 30 10.0 17 ea


Amplatz Type Renal Dilator/Sheath Set


M0062602500 08714729137122 Amplatz Type Renal Dilator/Sheath Set ea

Set Includes: Twelve Dilators (8F-30F Even Sizes), Four Amplatz Type Renal Sheaths (24F-30F Even Sizes), 8/10 Dilator/Sheath SetApplicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

Amplatz Type Graduated Renal Dilation Set


M0062601000 08714729005421 Amplatz Type Graduated Renal Dilator Set ea

Set Includes: Twelve Dilators (8F-30F Even Sizes), 8/10 Dilator/Sheath SetApplicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.



52

DILATORS AND SHEATHS (Continued)

8Fr Dilator

30Fr Dilator

10Fr Sheath 8Fr Stylet

Amplatz Type Renal Dilators


O.D. Size I.D. Size Total Length(cm) Unit(Fr) (mm) (Fr) (mm)

M0062601010 08714729005438 8 2.7 3 1.0 35 eaM0062601020 08714729005445 10 3.4 3 1.0 35 eaM0062601030 08714729005452 12 4.1 3 1.0 35 eaM0062601040 08714729005469 14 4.7 8 2.7 35 eaM0062601050 08714729005476 16 5.4 8 2.7 35 eaM0062601060 08714729005483 18 6.1 8 2.7 35 eaM0062601070 08714729005490 20 6.8 8 2.7 35 eaM0062601080 08714729005506 22 7.4 8 2.7 35 eaM0062601090 08714729005513 24 8.1 8 2.7 35 eaM0062601100 08714729005520 26 8.7 8 2.7 35 ea M0062601110 08714729005537 28 9.4 8 2.7 35 eaM0062601120 08714729005544 30 10.1 8 2.7 35 eaApplicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

(Individual Components)




53


DILATORS AND SHEATHS (Continued)

24Fr I.D., 17cm Length




Amplatz Type Renal Sheath


M0062601500 08714729005568 Amplatz Type Renal Sheath Set ea

Set Includes: Four Radiopaque PTFE Sheaths, 24 through 30 French I.D., 17cm LengthApplicable Medicare C-codes: C1894 - introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser

Amplatz Type Renal Sheaths (Individual Components)


I.D. Size Total Length(cm) Unit(Fr) (mm)

M0062601450 08714729430056 14 4.7 17 ea

M0062601460 08714729430070 16 5.3 17 ea

M0062601470 08714729430094 18 6.1 17 ea

M0062601480 08714729430117 20 6.7 17 ea

M0062601490 08714729430131 22 7.4 17 ea

M0062601510 08714729005575 24 8.1 17 ea

M0062601520 08714729005582 26 8.8 17 ea

M0062601530 08714729005599 28 9.4 17 ea

M0062601540 08714729005605 30 10.1 17 ea

M0069001230 08714729431671 30 10.1 20 ea


8Fr Stylet 8Fr Stylet10Fr PTFE Sheath

8/10 Dilator/Sheath Set


M0062601200 08714729005551 8 French Stylet with 10 French O.D. Safety Wire Introducer Sheath ea


(Set)



54


TORQUEABLE CATHETERS


Order Number GTIN Number DescriptionO.D. Size

(Fr)Working Length

(cm) Unit

M0064003001 08714729430261 C1 5 65 bx 5

M0064003011 08714729430278 C2 5 65 bx 5

M0064003021 08714729430285 Straight 5 65 bx 5

M0064003031 08714729430292 Bern 5 65 bx 5

M0064003041 08714729430308 JB1 5 65 bx 5

M0064004021 08714729430315 Straight 5 100 bx 5

M0064004031 08714729430322 Bern 5 100 bx 5

M0064004041 08714729430339 JB1 5 100 bx 5

M0064005031 08714729430346 Bern 5 40 bx 5


OCCLUSION BALLOON CATHETERS

Occluder™ Occlusion Balloon Catheters


Balloon Inflated O.D Catheter Size Usable Length(cm) Unit(Fr) (mm) (Fr) (mm)

M0062201070 08714729191988 26 8.5 5 1.7 65 ea

M0062201080 08714729191995 26 8.5 5 1.7 100 ea

M0062201090 08714729192008 34 11.5 7 2.3 65 ea

M0062201100 08714729161691 34 11.5 7 2.3 100 ea

Set Includes: Occlusion Balloon Catheter, Two-Way Stopcock and SyringeApplicable Medicare C-codes: C2628 - catheter, occlusion



55


DRAINAGE CATHETERS

C-Flex™ Malecot Catheter

Luer Lock Connector

Flexible Stylet

.038”EndHole

Malecot Nephrostomy Catheters


(Fr)Working Length

(cm) Unit

M0064101020 08714729005285 20 35 ea

M0064101030 08714729005292 24 35 ea

Set Includes: C-Flex Malecot Catheter, Two Flexible Stylets and Drainage Bag Connecting TubeApplicable Medicare C-codes: C1729 - catheter, drainage

Re-Entry™ Malecot Nephrostomy Catheter Sets


CatheterO.D. Size

(Fr)

CatheterWorking Length

(cm)

Re-Entry TipO.D. Size

(Fr)

Re-Entry TipTip Length

(cm) Unit

M0064101060 08714729005308 20 35 8 18 ea

M0064101070 08714729005315 24 35 8 18 ea

Set Includes: C-Flex Re-Entry Malecot Catheter, Two Flexible Stylets and Drainage Bag Connecting TubeApplicable Medicare C-codes: C1729 - catheter, drainage

Percuflex™ Locking Loop All Purpose Drainage Catheters with Fader Tip™


(Fr)Working Length

(cm) Unit

M0064102020 08714729079767 8.3 19 ea

M0064102030 08714729079774 10.3 19 ea

Set Includes: Percuflex Catheter with Fader Tip and Locking Pigtail, Trocar Stylet and Stiffening CannulaApplicable Medicare C-codes: C1729 - catheter, drainage



56

DRAINAGE CATHETERS (Continued)

Percuflex™ Locking Loop Nephrostomy Catheters with Fader Tip™


(Fr)Working Length

(cm) Unit

M0064102040 08714729192299 8.3 26 ea

M0064102050 08714729192305 10.3 27.6 ea

M0064102060 08714729192312 12 27 ea

Supplied With: Metal Stiffening Cannula, Flexible Stiffening Cannula and Septum CapApplicable Medicare C-codes: C1729 - catheter, drainage

Percuflex Combination Stent/Nephrostomy Catheter


(Fr)

Working Length FromHub to Loop

(cm)

Length FromLoop to Tip

(cm) Unit

M0064101260 08714729005254 8.3 25 24 ea

Includes: Stiffening Cannula, Septum CapApplicable Medicare C-codes: C1729 - catheter, drainage

Percuflex Locking Loop Nephrostomy Catheters

Order Number GTIN NumberWorking O.D. Size

(Fr)Length

(cm) Unit

M0064101110 08714729005223 8.3 26.5 ea

M0064101120 08714729005230 10.3 28.3 ea

Includes: Metal Stiffening Cannula with Echogenic Tip, Flexible Stiffening Cannula, Septum CapApplicable Medicare C-codes: C1729 - catheter, drainage




57

NOTES


58

NOTES

LITHOTR

IPSYPRODU

CTS



LITH

OTR

IPSY

PROD

UCT

S




59


LASER SYSTEMS

Lumenis™ Laser Systems


M0068408300 N/A Lumenis Pulse™ 120 H Holmium Laser ea

GA-0006801 N/A Lumenis Pulse 120 H Laser with Moses eaM0068408100 N/A Lumenis Pulse 100 H Laser eaM0068408290 08714729430636 Lumenis VersaPulse™ PowerSuite™ 100 Watt Holmium Laser eaM0068408280 N/A Lumenis 80/100 Watt Holmium Laser ea

M0068408270 08714729470380 Lumenis VersaPulse PowerSuite 60 Watt Holmium Laser ea

GA-1008946 N/A Lumenis Pulse 50H Laser ea

GA-2000435 N/A Lumenis Pulse 30H Laser ea

SA-20037840 N/A Lumenis Pulse 30H Cart ea

AC-2004192 N/A Lumenis Pulse 30H Arm eaApplicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

Lumenis Pulse™ 120H Moses UpgradeOrder Number GTIN Number Description UnitSPMO-0006800 N/A Lumenis Pulse 120H Moses Upgrade eaApplicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

LASER FIBERS

Flexiva™ TracTip™ High Power Single-Use Laser Fibers

Order Number GTIN Number Description UnitM0068403960 08714729808169 Flexiva TracTip 200 High Power Single-Use Holmium Laser Fiber eaM0068403961 08714729808176 Flexiva TracTip 200 High Power Single-Use Holmium Laser Fiber bx 5Applicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

Flexiva ID TracTip High Power Single-Use Laser FibersOrder Number GTIN Number Description UnitM006R8403960 08714729963837 Flexiva ID TracTip 200 Laser Fiber Single eaM006R8403961 08714729963844 Flexiva ID TracTip 200 Laser Fiber Box 5 bx 5Applicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

Flexiva High Power Single-Use Laser FibersOrder Number GTIN Number Description UnitM0068403910 08714729808145 Flexiva 200 High Power Single-Use Holmium Laser Fiber eaM0068403920 08714729808183 Flexiva 365 High Power Single-Use Holmium Laser Fiber eaM0068403930 08714729808206 Flexiva 550 High Power Single-Use Holmium Laser Fiber eaM0068403940 08714729808121 Flexiva 1000 High Power Single-Use Holmium Laser Fiber eaM0068403911 08714729808152 Flexiva 200 High Power Single-Use Holmium Laser Fiber bx 5M0068403921 08714729808190 Flexiva 365 High Power Single-Use Holmium Laser Fiber bx 5M0068403931 08714729808213 Flexiva 550 High Power Single-Use Holmium Laser Fiber bx 5M0068403941 08714729808138 Flexiva 1000 High Power Single-Use Holmium Laser Fiber bx 5Applicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

(For use with non-RFID Lumenis Ho:YAG and Nd:YAG Lasers)

(For use with RFID Lumenis Ho:YAG and Nd:YAG Lasers)

(For use with non-RFID Lumenis Ho:YAG and Nd:YAG Lasers)



60


LASER FIBERS (Continued)

Flexiva™ ID High Power Single-Use Laser Fibers


M006R8403910 08714729963752 Flexiva ID 200 Laser Fiber Single ea




M006R8403911 08714729963769 Flexiva ID 200 Laser Fiber Box 5 bx 5





AccuTrac™ Single-Use Holmium Laser Fibers


M0068404110 08714729802716 AccuTrac 200 Single-Use Holmium Laser Fiber ea

M0068404112 08714729802709 AccuTrac 200 Single-Use Holmium Laser Fiber bx 5


AccuMax™ Single-Use Holmium Laser Fibers


M0068404010 08714729784586 AccuMax 200 Single-Use Holmium Laser Fiber ea




M0068404012 08714729784623 AccuMax 200 Single-Use Holmium Laser Fiber bx 5





Moses™ Laser Fibers


AC-10030100 N/A Moses 200 D/F/L Laser Fiber – Max 2J, 80Hz, 60W ea

AC-10030110 N/A Moses 365 D/F/L Laser Fiber – Max 6J, 80Hz, 120W ea

AC-10030120 N/A Moses 550 D/F/L Laser Fiber- Max 6J, 80Hz, 120W ea


(For use with RFID Lumenis Ho:YAG and Nd:YAG Lasers)

(For use with Dornier (H 20) and New Star Lasers with SMA-905 connectors)

(For use with Dornier (H 20) and New Star Lasers with SMA-905 connectors)



61


LASER FIBERS (Continued)

SlimLine EZ™ SIS Single-Use Laser Fibers


AC-1001635 07290109140261 SlimLine 200 DFL Fiber (Smooth Tip) ea

M0068409201 07290109140193 SlimLine EZ 200 SIS Single-Use Laser Fiber bx 3




SlimLine™ SIS Reusable Laser Fibers


M0068409230 07290109140223 SlimLine 200 SIS Reusable Laser Fiber ea





LASER ACCESSORIES

Accessories for Lumenis Brand Holmium and Dual Wavelength Laser Systems


M0068408570 N/A Laser Radiation Warning Sign ea

M0068408580 N/A Holmium Laser Safety Glasses ea

M0068408590 N/A Holmium Laser Safety Goggles ea

M0068408800 N/A 200 Micron Fiber Stripper (For reusable fibers only) ea

M0068408820 N/A 365 Micron Fiber Stripper (For Lumenis Fibers) ea



M0068408850 N/A SlimLine Steam Sterilization Tray ea

M0068408860 N/A Cutting Scissors ea

M0068408870 N/A Cleaving Tool ea

M0068408880 N/A Fiber Inspection Microscope ea


(For use with all Lumenis Lasers)

(For use with all Lumenis Lasers)



62


DUAL-ENERGY LITHOTRIPTER SYSTEMS

Swiss LithoClast™ Trilogy System Kit


M006840200K0 761335312399 Swiss LithoClast Trilogy System Kit ea

Included in Kit:

M0068402010 7613353125707 Swiss LithoClast Trilogy Console ea

M0068402030 7613353125776 Swiss LithoClast Trilogy Handpiece Kit ea

M0068402050 7613353125806 Swiss LithoClast Trilogy Foot Switch ea

M0068403590 7613353133351 Trilogy Reusable Torque Wrench ea

M0068401810 7613353125820 Stone Catcher Holder ea

M0068401800 7613353125769 HDMI-VDI Cable (10m) ea

M0068401820 7613353125837 Filling Bottle ea

M0068401830 7613353125844 Bottle of Demineralized Water (2.5l) ea

M0068401850 7613353125721 Power Cord (US - 6m) ea

M0068401860 7613353140175 Swiss LithoClast Trilogy System IFU ea

M0068401890 7613353140199 Quick Guide ea

M0068401620 7613353125851 Cleaning Rod for Trilogy Probes (3.4mm and 3.9mm) ea


Swiss LithoClast Trilogy Single-Use Probe Kits


M0068403550 7613353123703 3.9mm x 440mm Trilogy Probe Kit ea









*Single-Use Probe Kits include a probe and Stone Catcher.Applicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

Swiss LithoClast Trilogy System Accessories


M0068402030 7613353125776 Swiss LithoClast Trilogy Handpiece Kit* ea

M0068402050 7613353125806 Swiss LithoClast Trilogy Foot Switch ea

M0068403590 7613353133351 Trilogy Reusable Torque Wrench ea

M0068401610 7613353125790 Cleaning Rod for Trilogy Handpiece ea


M0068401800 7613353125769 HDMI-VDI Cable (10m) ea

M0068401820 7613353125837 Filling Bottle ea

M0068401830 7613353125844 Bottle of Demineralized Water (2.5l) ea

M0068401850 7613353125721 Power Cord (US - 6m) ea

*Swiss LithoClast Trilogy Handpiece Kit includes a Trilogy Reusable Torque Wrench, shipped separately.Applicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

*



63


DUAL-ENERGY LITHOTRIPTER SYSTEMS (Continued)

Swiss LithoClast™ Trilogy System Accessories (Continued)


M0068401860 7613353140175 Swiss LithoClast Trilogy System IFU ea

M0068401890 7613353140199 Quick Guide ea

M0068401620 7613353125851 Cleaning Rod for Trilogy Probes (3.4mm and 3.9mm) ea

M0068401630 7613353125868 Cleaning Rod for Trilogy Probes (1.9mm) ea

M0068401790 7613353125899 Trilogy Handpiece Suction Connector ea

*Swiss LithoClast Trilogy Handpiece Kit includes a Trilogy Reusable Torque Wrench, shipped separately.Applicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

Swiss LithoClast Trilogy Single-Use Accessories


M0068402981 7613353126384 Stone Catcher for Trilogy bx 5

M0068402061 7613353132118 Double Suction Bags bx 5

M0068402071 7613353133931 Suction Bag 5l bx 10


Swiss LithoClast Trilogy Cart


M0068401760 7613353125912 Swiss LithoClast Trilogy Cart ea


Trilogy Service Options

GTIN Number Description

SRVM006LITRIEC1001 Trilogy EssentialCare 1 YR POS




SRVM006LITRIEC1005 Trilogy EssentialCare 1 YR POST




SRVM006LITRITC1001 Trilogy TotalCare 1 YR POS




SRVM006LITRITC1005 Trilogy TotalCare 1 YR POST




(Optional)



64



Swiss LithoClast™ Select Accessories


M0068403020 08714729820123 Swiss LithoClast Select Directions for Use ea

M0068403030 08714729820130 Swiss LithoClast Select Error Message Laminate N/C

M0068403040 08714729820413 Vario Ultrasound Handpiece Kit ea

M0068407030 08714729520016 Foot Pedal ea


M0068407070 08714729520030 Compressed Air Tube - 3m ea

M0068407080 08714729520047 Power Cord ea

M0068407090 08714729520054 Spare Fuses ea

M0068407200 08714729520092 Pneumatic Handpiece Kit ea

M0068403180 08714729820383 Vario Ultrasound Handpiece 5mm Wrench ea

M0068403050 08714729820390 Vario Ultrasound Handpiece 8mm Wrench ea

M0068407280 08714729520108 Pneumatic Handpiece Tube with Q-connect (3M) ea

M0068407290 08714729520115 Pneumatic Handpiece Shipping Case ea

M0068407501 08714729520139 Stone Catcher with Tubing and Adapter (5/box) ea

M0068403060 08714729802877 Angled Suction Connector - Stone Catcher ea

M0068403070 08714729820079 Straight Suction Connector - Stone Catcher ea

M0068403220 08714729820451 Vario Ultrasound Handpiece Shipping Case ea

M0068403160 08714729802884 Angled Suction Connector - Suction Tubing ea

M0068403170 08714729820086 Straight Suction Connector - Suction Tubing ea

M0068403240 08714729809982 Hose Sterilization Cap ea

M0068403190 08714729820376 Vario Ultrasound Distal Protective Cap ea

M0068403200 08714729820420 Vario Ultrasound Handpiece O-Ring ea

M0068403210 08714729820062 Straight Suction Connector O-Ring ea

M0068403110 08714729820437 Vario Ultrasound Handpiece Quick Table ea


Ultrasound Probe

Swiss LithoClast Ultrasound Probes


M0068407140 08714729470236 3.3 mm x 330 mm Swiss LithoClast Ultrasound Probe ea




For use only with Swiss LithoClast Select System Model no. 840-300k, Swiss LithoClast Ultra System Model no. 840-700k, or Upgraded System Model no. 840-701U.Applicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

(Not compatible with Swiss LithoClast Standard Probe)



65



Swiss LithoClast™ Pneumatic Probes


M0068407310 08714729516620 0.8 mm x 668 mm Disposable Pneumatic Probe ea

M0068407320 08714729470250 1.0 mm x 497 mm Disposable Pneumatic Probe* ea

M0068407330 08714729516637 1.0 mm x 570 mm Disposable Pneumatic Probe** ea



M0068407390 08714729430599 0.89 mm x 940 mm Flexible Ureteroscopy Probe for Swiss LithoClast System ea

*Designed for use with Ultrasound probes 840-714 & 840-715 **Designed for use with Ultrasound probes 840-716 & 840-717Applicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

Swiss LithoClast Service Options

GTIN Number Description

SRVM006LIT2005 LithoClast EssentialCare 1 YR POST






66

NOTES

PROSTATEH

EALTH



PROS

TATE

HEA

LTH




67

PROSTATE HEALTH

BPH LASER SYSTEMS

GreenLight™ Laser Therapy

Order Number Description Unit

Lasers

0010-0210S-G0 GreenLight XPS™ Laser System ea

Fibers

0010-2400 Angled Delivery Device, GreenLight XPS MoXy™ ea

0010-2090 Angled Delivery Device, GreenLight HPS ea

0010-2092 Angled Delivery Device, GreenLight HPS EA ea

Accessories (Protective Filters)

0010-0721 Video Camera Gold Filter for Rigid Endoscope 1.25" diameter ea

0010-0722 Video Camera Gold Filter for Rigid Endoscope .095” diameter ea

0010-0725 Video Camera Blue Filter for Rigid Endoscope 1.25" diameter ea

0010-0726 Video Camera Blue Filter for Rigid Endoscope .095" diameter ea

0010-0728 Video Camera Green Filter for Rigid Endoscope 1.23" diameter ea

Accessories (Protective Eyewear)

0010-0010 GreenLight Physician Protective Eyewear ea

0010-0011 GreenLight Physician Eyewear OTG ea

0010-7031 GreenLight Spectator Eyewear ea

Accessories (Other)

0010-0231 GreenLight XPS Laser in Use Sign (set of 2) ea

0010-0068 GreenLight XPS Operator's Manual ea


Rezūm™ Water Vapor Therapy

Order Number Description Unit

G2200-003 Rezūm Generator ea

D2201-5SB Rezūm Delivery Device Kit for BPH bx 5


Holmium Laser Therapy


M0068408100 N/A Lumenis Pulse™ 100 H Laser ea

M0068408300 N/A Lumenis Pulse 120 H Laser ea

GA-0006801 N/A Lumenis Pulse 120 H Laser with Moses ea

AC-1000729 07290109140278 Xpeeda™ 550 DSL Fiber, Side Firing Fiber ea


(vaporization and enucleation)



68

PROSTATE HEALTH

FORCEPS

Piranha™ 3 French Ureteroscopic Biopsy Forcep

OrderNumber

GTINNumber

Jaw O.D.(mm)

Length(cm)

Recommended Working Channel(mm) Unit

M0065051600 08714729302599 1.0 115 1.1 ea


SUTURE CAPTURING DEVICES

Capio™ RP Suturing Devices for Radical Prostatectomy

Order Number GTIN Number Description Size Unit

M0068321010 08714729470212 Capio RP Suture Capturing Device for an open radical prostatectomy ea

M0068331361 08714729646334 Bondek™ Absorbable, braided coated PGA suture, with a TC taperpoint needle (dart) and a T 26mm 1/2 circle taper needle, 36"

2.0 bx 12




69

PROSTATE HEALTH

PERIRECTAL HYDROGEL SPACER

SpaceOAR™ Hydrogel

Product Code Description Unit

SO-2101 SpaceOAR System ea

SO-2104SB SpaceOAR multi-pack 4 units

Applicable Medicare C-codes: 55874



70

NOTES

PROCEDUR

EACCESSOR

IES



PROC

EDU

RE

ACCE

SSOR

IES




71


INFLATION DEVICE



M0067101131 08714729761815 20mL Encore 26 Inflator with Pressure Gauge bx 5

M0067101140 08714729755814 20mL Encore 26 Inflator with Pressure Gauge ea


BLADDER EVACUATION DEVICE

Urovac™ Bladder Evacuator containsL AT E X


M0067301251 08714729033769 Urovac Bladder Evacuator bx 10




72


IRRIGATION DEVICES AND ACCESSORIES

From IrrigationFluid Reservoir

Irrigation to Scope

SAPS™ Single Action Pumping System


M0067201001 08714729045069 Single Action Pumping System bx 5

System Includes: 10mL Vacuum Syringe, Check Valve with Adjustable Length Connecting TubesApplicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.

"T" Fitting

Roller Clamp

10cc Syringe

SAPS™ CF Continuous Flow Single Action Pumping System


M0067201011 08714729045076 Single Action Pumping System CF bx 5

System Includes: 10mL Vacuum Syringe, Continuous Flow Adjustable Length Tubing System with Dual-Check Valve and Roller ClampApplicable Medicare C-codes: There are no applicable Medicare C-codes for the above products.



73


OTHER

UroLok™ II Scope Adaptor


M0067301401 08714729066569 UroLok II Scope Adaptor bx 10


ESP™ Radiation Reduction Examination Gloves containsL AT E X

Order Number GTIN Number Description Size Unit

M0067051021 08714729044963 ESP Radiation Reduction Examination Gloves 7 bx 3 pairs

M0067051031 08714729191117 ESP Radiation Reduction Examination Gloves 71/2 bx 3 pairs


M0067051051 08714729044994 ESP Radiation Reduction Examination Gloves 81/2 bx 3 pairs



Connecting Tubes


M0067401000 08714729010944 30cm Connecting Tube for 3 through 6Fr Catheters ea

M0067401010 08714729012832 30cm Connecting Tube for 7 through 10Fr Catheters ea

M0067401020 08714729010951 30cm “Y” Connecting Tube for Two 3 through 6Fr Catheters ea


Ureteral Catheter Connectors


M0067401100 08714729010982 Connection for 3 through 6Fr Catheters with Luer Lock Fitting ea

M0067401110 08714729010975 Connection for 7 through 10Fr Catheters with Luer Lock Fitting ea


Drainage Bag Connectors


M0067401200 08714729010999 Connection for Female Luer Lock Fitting to Drainage Bag ea

M0067401220 08714729011002 Connection for 3 through 6Fr Ureteral Catheters to Drainage Bag ea


Gateway™ Advantage Y-Adapter


M0067301501 08714729845331 Gateway Advantage Y-Adapter bx 10




74

NOTES

PELVIC FLOORPRODU

CTS



PELV

IC F

LOOR

PROD

UCT

S




75


MID-URETHRAL SLING SYSTEMS

Advantage Fit™ System (Transvaginal)


M0068502110 08714729772880 Advantage Fit System ea

M0068502120 08714729961925 Advantage Fit Blue System ea

Each System includes One (1) Delivery Device and One (1) Mesh AssemblyApplicable Medicare C-codes: C1771 - repair device, urinary, incontinence, with sling graft

Curved Needle Tip

Advantage™ System (Transvaginal)


M0068502000 08714729470274 Advantage System ea

M0068502050 08714729961918 Advantage Blue System ea


Curved Needle Tip

Lynx™ System (Suprapubic)


M0068503000 08714729718949 Lynx System ea

M0068503010 08714729961932 Lynx Blue System ea

Two (2) Delivery Devices and One (1) Mesh AssemblyApplicable Medicare C-codes: C1771 - repair device, urinary, incontinence, with sling graft



76


MID-URETHRAL SLING SYSTEMS (Continued)

Curved Halo

Obtryx™ II System with PrecisionBlue™ Design Halo or Curved (Transobturator)


M0068504110 08714729839255 Obtryx II System - Curved ea

M0068505110 08714729837565 Obtryx II System - Halo ea

Each System includes Two (2) Delivery Devices and One (1) Mesh AssemblyApplicable Medicare C-codes: C1771 - repair device, urinary, incontinence, with sling graft

Obtryx System Halo or Curved (Transobturator)


M0068504000 08714729718963 Obtryx System - Curved ea

M0068505000 08714729718987 Obtryx System - Halo ea

Each System includes Two (2) Delivery Devices and One (1) Mesh AssemblyApplicable Medicare C-codes: C1771 - repair device, urinary, incontinence, with sling graft

Deployment Mechanism

Mid-line Marker

Delivery Tip

Solyx™ SIS System (Single Incision)


M0068507000 08714729774044 Solyx SIS System ea

M0068507010 08714729961901 Solyx Blue SIS System ea


INJECTABLE IMPLANT

Coaptite™ Injectable Implant


M0068903000 08714729804796 1ml Syringe ea

M0068903040 08714729819530 Sidekick™ Rigid Needle ea

Applicable Medicare C-codes: L8606 - Injectable bulking agent, synthetic implant, urinary tract, 1ml syringe, includes shipping and necessary supplies



77


SUTURING SYSTEMS

Capio™ Slim Suture Capturing Device


M0068318250 08714729838005 Capio Slim Suture Capturing Device ea

M0068318261 08714729842224 Capio Slim Suture Capturing Device bx 5

Applicable Medicare C-codes: C2631 - repair device, urinary, incontinence, without sling graft

Dart Carrier

Capio Suture Capturing Devices

Order Number GTIN Number DescriptionSize

(mm) x (cm) Unit

M0068311251 08714729257615 Open Access - for sensory/direct visual control where a trocar is not employed, i.e., Mini Incision Burch, Sacrospinous Fixation or Vaginal Paravaginal Repair

25cm length bx 4

M0068312321 08714729257622 Standard - for direct vision endoscopic, open or transvaginal use 12mm x 32cm bx 4

Applicable Medicare C-codes: C2631 - repair device, urinary, incontinence, without sling graft

Capio Sutures

Order Number GTIN Number Description Size Closest Equivalent Unit

M0068331231 08714729257660 Non-absorbable, polypropylene monofilament, double armed with two TC tapercut needles (darts), 48" 0 Surgilene™ Sutures /

Prolene™ Sutures bx 12

M0068331241 08714729257677Non-absorbable, polypropylene monofilament, double armed with a TC tapercut needle (dart) and a T 26mm 1/2 circle taper needle, 36"

0 Surgilene Sutures / Prolene Sutures bx 12

M0068331131 08714729257646 Non-absorbable, coated braided polyester, double armed with two TC tapercut needles (darts), 48" 0 TI-CRON™ Sutures /

Ethibond™ Sutures bx 12

M0068331141 08714729257653Non-absorbable, coated braided polyester, double armed with a TC tapercut needle (dart) and a T 26mm1/2 circle taper needle, 36"

0 TI-CRON Sutures / Ethibond Sutures bx 12

M0068331371 08714729761822Monodek™ Absorbable, monofilament PDO, double armed with a TC tapercut needle (dart) and a T 26mm 1/2 circle taper needle, 48"

0 PDS™ Sutures bx 12

M0068332131 08714729298205 Bondek™ Plus Suture, absorbable, coated braided PGA, double armed with two TC tapercut needles (darts), 48" 0 Dexon™ II Mesh /

Vicryl™ Mesh bx 12




78


SACROCOLPOPEXY

Upsylon™ Y-Mesh


M0068318200 08714729839217 Upsylon Y-Mesh ea

M0068318210 08714729848097 Colpassist™ Vaginal Positioning Device ea

M0068318220 08714729848103 Upsylon Y-Mesh and Colpassist Vaginal Positioning Device Kit ea

Applicable Medicare C-codes: C1763 - connective tissue, non-human (includes synthetic)

Polyform™ Synthetic Mesh

Order Number GTIN Number DescriptionSize(cm) Unit

M0068402580 08714729839224 Polyform Synthetic Mesh 10 x 15 ea

M0068402581 08714729839231 Polyform Synthetic Mesh 10 x 15 bx 5

M0068402590 08714729845256 Polyform Synthetic Mesh 15 x 20 ea

Applicable Medicare C-codes: C1763 - connective tissue, non-human (includes synthetic)

PELVIC FLOOR ACCESSORIES

Single-Step™ Pelvic Drape


M0068201060 08714729077329 Single-Step™ Pelvic Drape ea




79

NOTES


80

NOTES


81

8/10 Dilator/Sheath Set ............................................ 53

Accessories for Lumenis Brand Holmium and Dual Wavelength Laser Systems ................. 61

AccuMax™ Single-Use Holmium Laser Fibers ..........60

AccuTrac™ Single-Use Holmium Laser Fibers...........60

Advantage™ System (Transvaginal) ......................... 75

Advantage Fit™ System (Transvaginal) .................... 75

Amplatz Super Stiff™ Coated Guidewires ..................9

Amplatz Type Graduated Renal Dilation Set ............51

Amplatz Type Renal Dilators .................................... 52

Amplatz Type Renal Dilator/Sheath Set ...................51

Amplatz Type Renal Sheath ..................................... 53

Axxcess™ Catheter: Open End Ureteral Catheter .....45

Bagley Helical Stone Retrieval Baskets ....................20

Capio™ RP Suturing Devices for Radical Prostatectomy ...................................68

Capio™ Slim Suture Capturing Device ...................... 77

Capio Suture Capturing Devices ............................... 77

Capio Sutures ............................................................ 77

C-Flex™ Ureteral Catheters: Flexible Tip Open End Ureteral Catheter Sets ....45

C-Flex Ureteral Catheters: Open End Ureteral Catheter Sets ........................46

C-Flex Ureteral Catheters: Pigtail Ureteral Catheter Sets ..............................46

Clear Renal Sheath .....................................................51

Coaptite™ Injectable Implant .................................... 76

Connecting Tubes ..................................................... 73

Contour™ Injection Stent Sets ................................... 37

Contour Ureteral Stent Sets ......................................34

Dakota™ Nitinol Stone Retrieval Devices ................. 19

Drainage Bag Connectors ......................................... 73

Dual Lumen Ureteral Catheter..................................43

Encore™ 26 Inflator ..........................................15, 51, 71

Escape™ Nitinol Stone Retrieval Baskets ................. 19

ESP™ Radiation Reduction Examination Gloves ...... 73

Flexiva™ High Power Single-Use Laser Fibers .........59

Flexiva™ TracTip™ High Power Single-Use Laser Fibers ..........................................................59

Flexiva ID High Power Single-Use Laser Fibers .......60

Gateway™ Advantage Y-Adapter ............................. 73

Gemini™ Paired Wire Helical Stone Retrieval Baskets ...................................................21

Graspit™ Nitinol Stone Retrieval Forceps .................20

GreenLight™ Laser Therapy ...................................... 67

Holmium Laser Therapy ........................................... 67

Imager™ II Urology Torque Catheters .................43, 54

Leslie Parachute™ Multi-Wire Stone Sweeping Devices ................................................ 23

Lingeman Percutaneous Tract Kit with ZIPwire™ Guidewire ....................................49

LithoCatch™ Immobilization Device ......................... 23

LithoVue Empower™ Bundle ....................................... 5

LithoVue Empower Bundle with Basket ..................6

LithoVue Empower Retrieval Deployment Device .... 5

LithoVue™ Service Options .........................................6

LithoVue SUD only ...................................................... 5

LithoVue System Workstation ................................... 5

LithoVue with Image and Video Capture ................. 5

Lubriglide™ Coated Guidewires (Fixed Core) ........... 10

Lubriglide Coated Guidewires (Fixed Core, Stiff Bodied) ..................................... 10

Lubriglide Coated Guidewires (Moveable Core) ...... 10

Lumenis Pulse™ 120H Moses Upgrade .....................59

Lumenis™ Laser Systems ...........................................59

Lynx™ System (Suprapubic) ...................................... 75

Malecot Nephrostomy Catheters ............................. 55

Mardis Soft Ureteral Stent Sets ................................38

Moses™ Laser Fibers ..................................................60

Navigator™ HD Ureteral Access Sheath Sets .............13

Navigator Ureteral Access Sheath Sets .....................13

NaviGuide™ Percutaneous Access Needle ...............50

NephroMax™ High Pressure Nephrostomy Balloon Catheters.................................................50

Nottingham One-Step Hydrogel Coated Ureteral Dilators ...................................... 16

Obtryx™ System Halo or Curved (Transobturator) ... 76

Obtryx II System with PrecisionBlue™ Design Halo or Curved (Transobturator) ......................... 76

Product Index


82

Occluder™ Occlusion Balloon Catheters ...................54

OptiFlex™ Nitinol Stone Retrieval Baskets ...............20

Passport™ Balloon Dilatation Catheters....................15

Percuflex™ Combination Stent/Nephrostomy Catheter ................................................................56

Percuflex Locking Loop All Purpose Drainage Catheters with Fader Tip™ .................................... 55

Percuflex Locking Loop Nephrostomy Catheters ...56

Percuflex Locking Loop Nephrostomy Catheters with Fader Tip™ .....................................................56

Percuflex Plus Ureteral Stent Sets ............................30

Percuflex Ureteral Stents .......................................... 33

Percuflex Urinary Diversion Stent Sets ....................40

Percutaneous Access Set ..........................................49

Percutaneous Access Sets – Pigtail Catheter ...........49

Percutaneous Tract Kit with ZIPwire Guidewire ......49

Piranha™ 3 French Ureteroscopic Biopsy Forcep .....68

Polaris™ Loop Ureteral Stent Sets .............................28

Polaris Ultra Ureteral Stent Sets ...............................26

Polyform™ Synthetic Mesh........................................ 78

PTFE Coated Guidewires (Fixed Core) ........................9

PTFE Coated Guidewires (Fixed Core, Stiff Bodied) ...9

PTFE Coated Guidewires (Moveable Core) .................9

Re-Entry™ Malecot Nephrostomy Catheter Sets ..... 55

Retromax™ Plus Endopyelotomy Stents ..................40

Rezūm™ Water Vapor Therapy .................................. 67

SAPS™ CF Continuous Flow Single Action Pumping System ........................... 72

SAPS™ Single Action Pumping System .................... 72

Segura Hemisphere™ Stone Retrieval Baskets ........ 22

Sensor™ Dual-Flex Nitinol Guidewires with Hydrophilic Tip ............................................... 7

Sensor PTFE-Nitinol Guidewires with Hydrophilic Tip ............................................... 7

Single-Step™ Pelvic Drape ........................................ 78

SlimLine EZ™ SIS Single-Use Laser Fibers ................ 61

SlimLine™ SIS Reusable Laser Fibers ........................ 61

Solyx™ SIS System (Single Incision) .......................... 76

SpaceOAR™ Hydrogel ................................................69

Stone Cone™ Nitinol Urological Retrieval Coils ........ 23

Stretch™ VL Flexima™ Ureteral Stent Sets .................39

Swiss LithoClast™ Pneumatic Probes .......................65

Swiss LithoClast Trilogy Cart .....................................63

Swiss LithoClast Select Accessories .........................64

Swiss LithoClast Service Options .............................65

Swiss LithoClast Trilogy System Kit ..........................62

Swiss LithoClast Trilogy Single-Use Accessories .....63

Swiss LithoClast Trilogy Single-Use Probe Kits .......62

Swiss LithoClast Trilogy System Accessories ...........62

Swiss LithoClast Ultrasound Probes ........................64

TLA Introducer Needle and Sheath Set ...................50

Tria™ Ureteral Stent .................................................... 25

Tricep™ Hooked-Prong Grasping Forceps ................ 22

Tricep Hooked-Prong Grasping Forceps with Spool Handle ................................................ 22

Trilogy Service Options .............................................63

Upsylon™ Y-Mesh ...................................................... 78

Ureteral Catheter Connectors ................................... 73

Ureteral Catheters: Angled Tip Ureteral Catheters .............................44

Ureteral Catheters: Open End Ureteral Catheters ..............................44

Ureteral Dilatation Set .............................................. 16

Ureteral Dilators ........................................................ 16

Ureteral Dilator System with Procedural Sheath Set ................................. 16

Ureteral Stent Positioners ........................................ 41

UroLok™ II Scope Adaptor ......................................... 73

UroMax Ultra™ Balloon Dilatation Catheters ........... 14

Urovac™ Bladder Evacuator .......................................71

Zebra™ Guidewires ......................................................8

Zero Tip™ Nitinol Stone Retrieval Baskets................ 19

ZIPwire™ Guidewires (Standard Shaft) ....................... 7

ZIPwire Guidewires (Stiff Shaft) .................................8

Product Index (continued)


83

C-CODE CROSS-REFERENCE TO BOSTON SCIENTIFIC PRODUCTS

BACKGROUND

C-codes are required by Medicare on claims where procedures are billed under the Outpatient Prospective Payment System (OPPS). They are used to track the types of devices used during applicable outpatient procedures and to ensure that both procedures and devices are appropriately billed. Claims can be returned if the primary device required for the procedure is not included on the same claim. Separate device reimbursement is not driven by C-code use. It is important to charge appropriately for device-related procedures because hospital’s charging practices will determine adequacy of future Medicare hospital outpatient rates. Medicare sets new hospital outpatient rates using hospital claims and cost data from prior years.

When hospitals fail to include appropriate device charges on the claim, this reduces future payment rates because the device-related costs are not captured for that service. As a result, it is important for hospitals to accurately reflect all procedure costs in insurance claims charges, including device cost, using the appropriate C-code, where applicable in conjunction with revenue code 278 Medical/Surgical Supplies and Devices - Other Implant.

Medicare does not have a C-Code category for every Boston Scientific Urology and Women’s Health product.

MEDICARE HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATIONS (APCS)

APCs refers to the groupings of procedure codes under 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, uniform payments for each procedure grouped within a given 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.

IMPORTANT - PLEASE NOTE

Health economic and reimbursement information provided by Boston Scientific Corporation is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice. Boston Scientific encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services that are rendered. Boston Scientific recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters. Boston Scientific does not promote the use of its products outside their FDA-approved label.

CPT Copyright 2015 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.


84

C-CODE RESOURCE LIST

CMS MANDATES SELECT C-CODES

Federal Register, November 15, 2004, Vol. 69 No. 219: Final Rule Medicare Hospital Outpatient Payment System. Please monitor for quarterly updates.

SELECT CMS (FORMERLY HCFA) PROGRAM MEMORANDA ADDRESSING PASS-THROUGH ITEMS

We encourage you to retain for your records all Program Memoranda related to changes to C-codes on the Pass-Through List to keep track of historical changes. Refer to the CMS website to access Program Memoranda. (http://www.cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp)

• November 20, 2005, Consolidated Device Edits; Hospital Outpatient Prospective Payment System (OPPS) Related Information.

• December 17, 2004, January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS); Transmittal 403; Pub. 100-04; Centers for Medicare & Medicaid Services (CMS)

• June 4, 2004, Summary of Changes; Transmittal 195; Pub 100-04; Centers for Medicare & Medicaid Services (CMS)

• July 2003 Update of the Hospital Outpatient Prospective Payment System (OPPS); Transmittal No. A-03-051, Centers for Medicare & Medicaid Services (CMS)

• Coding Information for Hospital Outpatient Prospective Payment System (OPPS), Transmittal No. A-00-42, Health Care Financing Administration, July 26, 2000. (Effective August 1, 2000; discard after October 1, 2001.)

• Update 1 — Coding Information for Hospital Outpatient Prospective Payment System (OPPS), Transmittal No. A-00-61, Health Care Financing Administration, September 6, 2000. (Effective October 1, 2000; discard after October 1, 2001.)

• Technical Corrections to Coding Information for Hospital Outpatient Prospective Payment System (OPPS), Transmittal No. A-00-72, Health Care Financing Administration, October 3, 2000. (Effective October 1, 2000; discard after October 1, 2001.)

• January 2001 Update: Coding Information for Hospital Outpatient Prospective Payment System (OPPS), Transmittal No. A-00-82, Health Care Financing Administration, November 3, 2000. (Effective January 1, 2001; discard after January 1, 2002.)

• Impact of the Benefits Improvement and Protection Act on Devices Eligible for Transitional Pass-Through Payments Under the Hospital Outpatient Prospective Payment System, Transmittal No. A-01-17, Health Care Financing Administration, January 31, 2001. (Effective January 20, 2001; discard after January 20, 2002.)

• Additional Information on Transitional Pass-Through Devices and Drugs, Transmittal No. A-01-40, Health Care Financing Administration, March 22, 2001. (Effective April 1, 2001; discard after April 1, 2002.)

• Categories for Use in Coding Devices Eligible for Transitional Pass-Through Payments Under the Hospital Outpatient Prospective Payment System, Transmittal A-01-41, Health Care Financing Administration, March 22, 2001. (Effective April 1, 2001; discard after April 1, 2002.)

• July 2001 Update to the Hospital Outpatient Prospective Payment System, Transmittal A-01-73, Health Care Financing Administration, June 1, 2001. (Effective dates vary; discard after July 1, 2002.)

• Technical Corrections Under the Hospital Outpatient Prospective Payment System (OPPS), Transmittal A-01-97, Centers for Medicare & Medicaid Services (CMS), August 8, 2001. (Effective dates vary; discard after April 1, 2002.)

• Medicare Program; Prospective Payment System for Hospital Outpatient Services; Interim Final Rule, November 13, 2000. http://www.access.gpo.gov/su_docs/fedreg/a001113c.html

• Office of the Inspector General; Medicare Program; Prospective Payment System for Hospital Outpatient Services: Revisions to Criteria to Define New or Innovative Medical Devices, Drugs, and Biologicals Eligible for Pass-Through Payments and Corrections to the Criteria for the Grandfather Provision for Certain Federally Qualified Health Centers; Interim Final Rule, August 3, 2000.http://www.access.gpo.gov/su_docs/fedreg/a000803c.html


85

TERMS AND CONDITIONS

Ordering Information

All orders should be placed directly with Customer Service by mail or telephone to:

Boston Scientific Corporation Attn: Customer Service

500 Commander Shea Blvd. Quincy, MA 02171

For Phone Orders Call Customer Service at 1.888.272.1001 For Fax Orders 1.888.272.9444

Please note that the above address is our Customer Service mailing address only.

The toll-free number is available between the hours of 8:30 am and 9:30 pm (Eastern Time) weekdays excluding national holidays.

For your convenience, Boston Scientific accepts orders by FAX. The toll-free FAX number is 1.888.272.9444.

STANDING ORDERS Boston Scientific accepts standing orders on all products. This convenience provides you with scheduled shipments using a single purchase order. Contact Customer Database Department at 1.888.325.1060 for details. Contact Customer Service for details on ordering, pricing, and delivery.

TERMS Terms are Net 30 Days. All shipments are F.O.B. Quincy, Massachusetts. Prices are subject to change without notice.

RETURNED GOODS Permission to return merchandise is required for all returns and may be withheld in the sole discretion of Boston Scientific. For authorization please contact the Customer Service Returns Department for a Return Goods Authorization (RGA) number at 1.800.862.1284.

The request for authorization must include:

ɮ Reason for the return ɮ Order number, lot number, quantity ɮ Purchase order number, Boston Scientific invoice number, date of invoice

A copy of the packing slip or invoice must accompany all merchandise returned to Boston Scientific. The Returned Goods Authorization (RGA) number must be clearly marked on the shipping container. Merchandise returned without an RGA number will not be accepted or considered returned for purposes of the warranty.

ɮ Merchandise processed in error by Boston Scientific will receive full credit if returned within 30 days of invoice date in saleable condition ɮ Other merchandise returned within 30 days of invoice date in saleable condition will receive full credit less a 10% Restocking Charge ɮ Merchandise returned past 31 days in saleable condition will receive full credit less a 30% Restocking Charge ɮ Material that is opened, damaged, expired or tampered with is not returnable for credit nor is product with less than six months of shelf life remaining ɮ Products manufactured as Specials or Custom products are not returnable for credit

Product returns should be shipped to: Boston Scientific Corporation, Customer Service Returns Department, 500 Commander Shea Blvd., Quincy, MA 02171 1.800.862.1284

SPECIFICATION CHANGES As we are continually improving our products, the equipment supplied may not agree in all details with the description and specifications shown in the catalog and/or price list. All prices and specifications are subject to change without notice.

Boston Scientific Corporation makes no warranties, express or implied, including but not limited to, any implied warranty of merchantability or fitness for a particular purpose, except as specifically set forth in the product labeling supplied with each device.

REGULATORY Boston Scientific distributes products in compliance with relevant regulations.

CAUTION: Accordingly for medical devices: Federal (USA) law restricts these devices to sale by or on the order of a physician. Please refer to package insert provided with the product for complete Indications for Use, Contraindications, Warnings, Precautions, Adverse Events and Instructions. Repliform Tissue Regeneration Matrix complies with U.S. Regulations in 21 CFR part 1271 Human Tissue Intended for Transplantation.

WARNING REGARDING SINGLE USE DEVICES Products marked as “single use” are for single use only. Do not reuse, reprocess or resterilize single-use products. Reuse, reprocessing or resterilization may compromise the structural integrity of the device and/or lead to device failure which in turn may result in patient injury, illness or death. Reuse, reprocessing or resterilization may also create a risk of contamination of the device and/or cause patient infection or cross-infection, including, but not limited to, the transmission of infectious disease(s) from one patient to another. Contamination of the device may lead to injury, illness or death of the patient. Boston Scientific Corporation assumes no liability with respect to instruments reused, reprocessed or resterilized and makes no warranties, express or implied, including, but not limited to, any implied warranties of merchantability or fitness for a particular purpose, with respect to any such instrument.

All trademarks are the property of their respective owners.

Boston Scientific Corporation 300 Boston Scientific Way Marlborough, MA 01752 www.bostonscientific.com

Ordering Information 1.888.272.1001

© 2020 Boston Scientific Corporation or its affiliates. All rights reserved.

UROPH-439105-AD JAN 2020

Documents

2020PRODUCT CATALOG AND ORDERING INFORMATION...Applicable Medicare C-codes: C1769 - guidewire Sensor PTFE-Nitinol Guidewires with Hydrophilic Tip Order Number GTIN Number Diameter