medical supply products: tracheostomy – a thru f manufacturers

mc sup prod trach a

Medical Supply Products: Tracheostomy – A thru F Manufacturers 1

This section lists the billing codes, manufacturer codes and units for tracheostomy supplies manufactured by companies with names that begin with the letters A-F. In this section “MAC” refers to maximum acquisition cost and “UPN” refers to the Universal Product Number. For additional help, refer to the Medical Supplies section in this manual. HCPCS codes are for reference only.

Treatment Authorization Requests (TARs) are issued only for products that exceed billing limitations, or where otherwise indicated. Miscellaneous procedure codes, such as 9999A or 9999C, may not be substituted.

MAC Guarantee Through The Department of Health Care Services (DHCS) negotiated a contract with a distributor, Independence Medical, toIndependence Medical Only establish maximum acquisition cost (MAC) agreements for tracheostomy products. The maximum acquisition cost listed

in the “MAC” column in this section reflects the guaranteed MAC only when providers buy tracheostomy products through Independence Medical. This price is not guaranteed if providers purchase directly from the manufacturer or another source. “Item” numbers listed in this section are Independence Medical item numbers.

Billing Instructions Claims submitted for contracted tracheostomy products must include both the billing code and either the UPN or item number. All attachments submitted with paper claims (invoice, catalog page or price list) must include the UPN or item number for the product being billed. If the UPN or item number is not pre-printed on the attachment, it should be handwritten on the attachment next to the supply for which it is required. If the UPN or item number is not included or is illegible the claim will be denied.

Computer Media Claims require the UPN or item number to be included in the Remarks field. All tracheostomy products must be billed to Medicare before being billing to Medi-Cal.

Effective Dates Tracheostomy products in this section are effective for dates of service on or after November 1, 2008, unlessotherwise noted.

2 – Medical Supply Products: Tracheostomy – A thru F Manufacturers October 2008

Effective for Dates of Service On or Before March 31, 2009 Only

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Billing Limitations Tracheostomy supplies are limited to the following quantities without authorization.

Billing Code Limitation

9916L, 9916M, 9916S, 9916U, 9916W No more than 90 in an 81-day period

9916N, 9916Y, 9916Z No more than 6 in an 81-day period

9916P, 9916Q, 9917P, 9917Q, 9917V No more than 3 in an 81-day period

9916R, 9916V, 9916X No more than 1 unit per dispensing and 4 dispensings in a year

9916T No more than 12 in a 365-day period

9917S No more than 15 in an 81-day period

9917T No more than 12 in an 81-day period

9917U No more than 18 in an 81-day period

9981E, 9981J No more than 90 in an 81-day period

9981F No more than 360 in an 81-day period

Filter Holder and Claims submitted for medical supply code 9916X (filter holder and integrated filter housing, and adhesive, for use as heat Integrated Filter Housing: and moisture exchange system) must include documentation of product cost (invoice, manufacturer catalog page orMedical Supply Code 9916X price list), as an attachment to the claim. This is a non-contracted product. The quantity for code 9916X (HCPCS code

A7509) is limited to no more than one unit per dispensing and 4 dispensings in a year, without authorization.

2 – Medical Supply Products: Tracheostomy – A thru F Manufacturers February 2009


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TRACHEOSTOMY

DescriptionItemNumber UPN

HCPCS (reference only)

BillingCode MAC

Unit ofMeasure

Allegiance – 3J

Trach care kit w/hydrogen peroxide,case 30

553T4692C 50380470058776 A4625 9981E $2.23 each

Trach care kit w/hydrogen peroxide 553T4692 0038047005908 A4625 9981E $2.40 each

Trach care kit w/two compartment tray basin

553T4691AC 50380470058788 A4625 9981E $1.21 each

Basic trach care kit, non-sterile 553T4691A 100380470058825 A4625 9981E $1.21 each

Trach care kit in two compartment tray 553T4691 630140073963 A4625 9981E $1.67 each

Mini trach care kit 553T3030A 50380470058790 A4625 9981E $1.02 each

Trach mask, adult, w/6" flex tube 55001248 0055001248 A7525 9917T $4.10 each

Trach mask, adult 55001227 0055001227 A7525 9917T $1.22 each

Airlife trach mask, pediatric 55001226 630140015055 A7525 9917T $1.80 each

Trach mask, adult 55001225 630140015048 A7525 9917T $1.26 each

Suction cath kit, 14Fr 554114 380470035512 A4624 9981F $1.79 each

Guaranteed maximum acquisition cost is through Independence Medical only. Independence Medical item numbers listed.



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BillingCode MAC

Unit ofMeasure

Cath N Glove suction kit w/peel pouch, 5Fr 554660A 630140014768 A4624 9981F $0.77 kit

Cath N Glove suction kit w/peel pouch, 8Fr 554661A 500054661A A4624 9981F $0.65 kit

Cath N Glove suction kit w/peel pouch, 10Fr

554662A 630140014782 A4624 9981F $0.65 kit


554664A 630140014799 A4624 9981F $0.65 each

Cath N Glove suction kit w/basin, 14Fr 554694T H1604694T5 A4624 9981F $0.51 each

Cath N Glove suction kit w/basin, 10Fr 554695T 50630140037304 A4624 9981F $0.61 each

Cath N Glove suction kit w/basin, 8Fr 554697T 630140037323 A4624 9981F $0.62 each

Cath N Glove catheter kit w/peel pouch, infant, 5/6Fr

554893T 000554893T A4624 9981F $0.53 each

Cath N Glove suction kit w/basin, 14Fr,100 sets per case

554894T 50630140143838 A4624 9981F $0.53 each

Suction Cath set w/gloves & basin, 10Fr 554895T 630140143857 A4624 9981F $0.54 each

Suction Cath set w/gloves & basin, 8Fr 554897T 630140143888 A4624 9981F $0.54 each


554898T 50380470012303 A4624 9981F $0.53 each

Tri-Flo no touch suction catheter kit, 14Fr 55T160C 50630140030527 A4624 9981F $0.97 each

Tri-Flo no touch suction catheter kit, 10Fr 55T161C 630140030515 A4624 9981F $1.14 each

Tri-Flo no touch suction catheter kit w/control valve, 18Fr

55T162C 00055T162C A4624 9981F $1.06 each




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BillingCode MAC

Unit ofMeasure

Suction Catheter w/o control valve, sterile, 14Fr

55T260 50630140263710 A4624 9981F $0.54 each

Tri-Flo straight-packed cath, 14Fr, 20" long 55T260C 630140263722 A4624 9981F $0.30 each

Control suction cath, straight-packed, 10Fr 55T261C 50630140263758 A4624 9981F $0.38 each

Tri-flo suction cath w/o cntrl port, 14Fr 55T60 630140026655 A4624 9981F $0.51 each

Tri-flo coil-packed cath, 14Fr, 20" long 55T60C H160T60C5V A4624 9981F $0.27 each

Tri-flo coil-packed cath, 10Fr, 20" long 55T61C H160T61C5W A4624 9981F $0.29 each

Tri-flo coil-packed cath, 18Fr, 20" long 55T62C 000055T62C A4624 9981F $0.40 each

Tri-flo coil-packed cath, 5/6Fr, 14" long 55T63C H160T63C5 A4624 9981F $0.36 each

Tri-flo suction cath w/o cntrl port, coil, pediatric, 8Fr

55T64 0000055T64 A4624 9981F $0.41 each

Tri-flo coil-packed cath, 8Fr, 15" long 55T64C H160T64C5 A4624 9981F $0.29 each

Decanulation plug, cap for trach, red 55MZ6DCP 000055MZ6DCP A7527 9917V $9.14 each




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BillingCode MAC

Unit ofMeasure

Bard – BA

8Fr Trach Suction Cath'n Sleeve Kit 570089080 H30200890801 A4624 9981F $2.25 each



18Fr (22") Catheter Kit w/cath'n sleeve device, single use

570089180 H30200891800 A4624 9981F $2.25 each


570089300 H30200893000 A4624 9981F $2.40 each


570089340 H30200893400 A4624 9981F $2.40 each

14-16Fr (16") Rubber bronchial coude catheter w/funnel end, x-ray opaque, one eye, whistle tip, single use

570107150 H30201071500 A4624 9981F $2.01 each

10-12Fr (16") Rubber suction catheter w/funnel end, x-ray opaque, two eyes, whistle tip, single use

570108100 H30201081000 A4624 9981F $1.66 each

14-16Fr (16") Rubber suction catheter w/funnel end, x-ray opaque, two eyes, whistle tip, single use

571018150 H30201081502 A4624 9981F $1.66 each




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BillingCode MAC

Unit ofMeasure

17-19Fr (16") Rubber suction catheter w/funnel end, x-ray opaque, two eyes whistle tip, single use

570108190 H30201081900 A4624 9981F $1.66 each

10-12Fr Rubber bronchial coude catheter, x-ray opaque, one eye, whistle tip, thumb valve

570109120 H30200109120 A4624 9981F $2.12 each


570109150 H30201091500 A4624 9981F $2.12 each


570109190 H30201091900 A4624 9981F $2.12 each




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BillingCode MAC

Unit ofMeasure

8Fr (18") Rubber suction catheter w/thumb valve, x-ray opaque, whistle tip, two eyes

570128080 H30201280800 A4624 9981F $1.86 each

10-12Fr (18") Rubber suction catheter w/thumb valve, x-ray opaque, whistle tip, two eyes

570128100 H30201281000 A4624 9981F $1.86 each


570128150 H30201281500 A4624 9981F $1.86 each


570128190 H30201281900 A4624 9981F $1.86 each

10-12Fr (18") Rubber catheter kit w/pop-up solution container

570140000 H30201400000 A4624 9981F $2.31 each

14-16Fr Tracheal suction latex catheter & glove kit, w/rubber whistle-tip cath, thumb valve, two side eyes

570140020 H30201400200 A4624 9981F $2.31 each

17-19Fr (18") Rubber catheter kit w/pop-up solution container

570140030 H30201400300 A4624 9981F $2.31 each

10Fr (22") Whistle tip catheter kit, w/two eyes, control vent

570140040 H30201400404 A4624 9981F $1.36 each


570140050 H303140054 A4624 9981F $1.36 each


570140060 H30201400601 A4624 9981F $1.36 each

5Fr (16") Whistle tip catheter kit w/1cm depth markings, two eyes, control vent

570140070 H30201400700 A4624 9981F $1.36 each




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BillingCode MAC

Unit ofMeasure

8Fr (16") Whistle tip catheter kit w/1cm depth markings, two eyes, control vent

570140080 H30201400800 A4624 9981F $1.36 each

10-12Fr (18") Rubber bronchial catheter kit w/ thumb valve, one eye, coude whistle tip

570140090 H30201400900 A4624 9981F $2.54 each

14-16Fr (18") Rubber bronchial catheter kit w/ thumb valve, one eye, coude whistle tip

570140100 H30201401000 A4624 9981F $2.54 each

8Fr (16") Suction catheter w/1cm depth markings, thumb valve, two eyes, whistle tip

570360080 H30203600800 A4624 9981F $1.31 each

10Fr (22") Suction catheter w/thumb valve, two eyes, whistle tip

570360100 H30203601000 A4624 9981F $1.31 each

14Fr (22") Suction catheter w/thumb valve, two eyes, whistle tip

570360140 H30203601400 A4624 9981F $1.31 each




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BillingCode MAC

Unit ofMeasure

Bivona – 3F

Custom trach w/hyperflex shaft w/aircuff,6 mm ID, 95 mm length

BJTRACHSP4 BJTRACHSP4 A7521 9916Z $320.65 each

Sleep Apnea Tracheostomy tube, 7.5 mm ID, 11.0 mm OD, 79 mm length

BJSAT757 05021312010926 A7520 9916Y $71.69 each

Sleep Apnea Tracheostomy tube, 73 mm length

BJSAT656 05021312010919 A7520 9916Y $71.69 each

Sleep Apnea Trach tube, 6.0 mm ID,9.0 mm OD, 68.0 mm length

BJSAT605 05021312010902 A7520 9916Y $75.02 each

Bivona trach vent, 16Fr, 55 mm long,10.5 mm ID, 24 mm OD

BJBV1655 05021312010001 A7520 9916Y $82.28 each

Tracheostoma vent, size 12, 13.5 ID,17.0 OD, 55 mm long

BJBV1255 05021312009920 A7520 9916Y $82.28 each

Tracheostoma vent, 12.0 mm ID, 15 mm OD, 55 mm long

BJBV1055 05021312009883 A7520 9916Y $82.28 each

Tracheostoma vent, size 10, 12 mm ID,15 mm OD, 36 mm long

BJBV1036 05021312009876 A7520 9916Y $77.44 each

Tracheostoma vent, size 9, 10.5 mm ID, 13.5 mm OD, 55 mm long

BJBV0955 05021312009838 A7520 9916Y $77.44 each

Tracheostoma vent, size 9, 10.5 mm ID, 13.5 mm OD, 36 mm long

BJBV0936 05021312009821 A7520 9916Y $77.44 each

Tracheostoma vent, size 9, 10.5 mm ID, 13.5 mm OD, 27.0 mm long

BJBV0927 05021312009814 A7520 9916Y $77.44 each




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BillingCode MAC

Unit ofMeasure

Tracheostoma vent, size 8, 9.5 mm ID,12 mm OD, 55 mm long

BJBV0855 05021312009791 A7520 9916Y $77.44 each

Tracheostoma vent, size 8, 9.5 mm ID, 12 mm OD, 36 mm long

BJBV0836 05021312009784 A7520 9916Y $77.44 each

Bivona laryngectomy tube, short, 11.0 mm ID, 14 mm OD, 55 mm length

BJBOSL3S 05021312008848 A7520 9916Y $113.74 each

Laryngectomy tube, short, 9.5 mm ID,12 mm OD, shaft length 55

BJBOSK1S 05021312008824 A7520 9916Y $113.74 each

Fome-Cuf pediatric silicone tracheostomy tube, 5.0 mm ID, 7.3 mm OD, 44.0 mm length

BJ85P050 05021312007032 A7521 9916Z $226.27 each

Fome-Cuf pediatric trach tube, 4.0 mm ID, 6.0 mm OD, 41.0 mm length, Silicone

BJ85P040 05021312007018 A7521 9916Z $226.27 each

Fome-Cuf adult trach tube kit w/sideport, autocontrol airway connector & CMD,9.5 mm ID, 13.3 mm OD, 98 mm length

BJ850195 05021312006813 A7521 9916Z $115.82 each


BJ850190 050213120006806 A7521 9916Z $115.82 each

Fome-Cuf adult trach tube kit w/sideport, autocontrol airway connector & CMD,8.0 mm ID

BJ850180 050213120006790 A7521 9916Z $115.82 each

Fome-Cuf adult trach tube kit w/sideport, autocontrol airway connector & CMD,7.0 mm ID, 10 mm OD, 80 mm length

BJ850170 05021312006783 A7521 9916Z $115.82 each


BJ850160 05021312006776 A7521 9916Z $115.82 each




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BillingCode MAC

Unit ofMeasure

Hyperflex trach tube, fixed 8 mm, cuffed,x-long

BJ75FHXL80 05021312015693 A7521 9916Z $114.95 each

Hyperflex trach tube, fixed 6 mm, cuffed,x-long

BJ75FHXL60 05021312015679 A7521 9916Z $114.95 each

Mid-Range with Aire-cuf trach tube, 9.0 BJ750190 05021312006431 A7521 9916Z $88.33 each

Mid-Range with Aire-Cuf trach tube, 8.0 BJ750180 05021312006424 A7521 9916Z $88.33 each




Pediatric trach tube, cuffed, tight to shaft, 5.5 mm ID, 46 mm length

BJ67P055 05021312006301 A7521 9916Z $208.64 each

Pediatric trach tube, tight to shaft, silicone wire reinforced tube, 5.0 mm ID, 7.3 mm OD, 44 mm length

BJ67P050 05021312006295 A7521 9916Z $215.10 each




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BillingCode MAC

Unit ofMeasure

Pediatric trach tube, tight to shaft, 4.5 mm ID, 42 mm length

BJ67P045 05021312006288 A7521 9916Z $208.64 each

Pediatric trach tube, tight to shaft, 4.0 mm ID, 41 mm length

BJ67P040 05021312006271 A7521 9916Z $208.64 each

Pediatric trach tube, Aire-Cuf, tight to shaft, 3.5 mm ID, 5.3 mm OD, 16Fr

BJ67P035 05021312006264 A7521 9916Z $215.10 each

Pediatric trach tube, Aire-Cuf, tight to shaft, 3.0 mm ID

BJ67P030 05021312006257 A7521 9916Z $215.10 each

Hyperflex adult tracheostomy tube w/fixed neck flange, 6.0 mm ID, 8.6 mm OD,70 mm length

BJ67FH60 05021312013750 A7520 9916Y $104.80 each

Trach tube, tight to shaft, cuffed, 9.8 mm ID, 98 mm long

BJ670195 05021312006103 A7521 9916Z $88.25 each

Trach tube, tight to shaft, cuffed, nonfenestrated, size 9, 98 mm length

BJ670190 05021312006097 A7521 9916Z $88.25 each

Trach tube, tight to shaft, cuffed,nonfenestrated, 8.5 mm ID

BJ670185 05021312006080 A7521 9916Z $88.25 each

Trach tube, tight to shaft, adult, cuffed, nonfenestrated, 8 mm ID, 11 mm OD,88 mm length

BJ670180 05021312006073 A7521 9916Z $85.91 each

Trach tube, tight to shaft, adult, cuffed, nonfenestrated, 7.55 mm ID, 10.4 mm OD, 80 mm length

BJ670175 05021312006066 A7521 9916Z $88.25 each

Adult trach tube, cuffed, nonfenestrated, no inner cannula, 7.0

BJ670170 05021312006059 A7521 9916Z $88.25 each




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BillingCode MAC

Unit ofMeasure

Trach tube, tight to shaft, cuffed, nonfenestrated, 6.5 mm ID, 9.4 mm OD,70 mm length

BJ670165 05021312006042 A7521 9916Z $88.25 each

Trach tube, tight to shaft, cuffed, no inner cannula, 6 mm

BJ670160 05021312006035 A7521 9916Z $85.91 each

Trach tube, tight to shaft, cuffed, non fenestrated, 5.0 mm ID, 7.3 mm OD,60 mm length

BJ670150 05021312006028 A7521 9916Z $85.60 each

Pediatric trach tube, Aire-Cuf, 5.5 mm ID, 46 mm long

BJ65P055 05021312006004 A7521 9916Z $242.00 each

Pediatric trach tube, Aire-Cuf, 5.0 mm ID, 7.3 mm OD, 44 mm long

BJ65P050 05021312005991 A7521 9916Z $229.90 each




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BillingCode MAC

Unit ofMeasure

Pediatric trach tube, 4.5 mm ID, 6.7 mm OD, 42 mm long

05021312005984 A7521 9916Z $226.12 each

Pediatric trach tube, Aire-Cuf, 4.0 mm ID, 41 mm long

05021312005977 A7521 9916Z $226.12 each

Pediatric trach tube, Aire-Cuf, 3.5 mm ID, 5.3 mm OD, 40 mm long

BJ65P035 050251312005960 A7521 9916Z $226.12 each

Neonatal trach tube, 2.5 mm ID BJ65N025 05021312005908 A7520 9916Y $226.12 each

Flextend Plus Standard Pediatric trach tube, 5.5 mm ID, 8.0 mm OD, 46 mm length

BJ60PFS55 05021312005892 A7520 9916Y $95.59 each

Flextend Plus Standard Pediatric trach tube, 5.0 mm ID, 7.3 mm OD, 44 mm length

BJ60PFS50 05021312005885 A7520 9916Y $95.59 each

Flextend Pediatric trach tube, 4.5 ID,6.7 OD, 42 mm distal shaft length, 30 mm proximal shaft

BJ60PFS45 05021312005878 A7520 9916Y $95.59 each




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BillingCode MAC

Unit ofMeasure

Flextend Plus Standard Pediatric trach tube, 4.0 mm ID, 6.0 mm OD, 41 mm distal shaft length, 25 mm proximal shaft length

BJ60PFS40 05021312005861 A7520 9916Y $94.16 each

Flextend Pediatric trach tube, 3.5 mm ID, 5.3 mm OD, 40 mm length

BJ60PFS35 05021312005854 A7520 9916Y $95.59 each

Flextend Pediatric trach tube, 3.0 mm ID, 4.7 mm OD, 10 mm Flextend length

BJ60PFS30 05021312005847 A7520 9916Y $95.59 each

Flextend Pediatric trach tube, 2.5 mm ID, 4.0 mm OD, 10 mm Flextend length

BJ60PFS25 05021312005830 A7520 9916Y $95.59 each

Flextend Plus Pediatric trach tube, 5.5 mm ID, 8.0 mm OD, 52 mm length

BJ60PFP55 05021312014757 A7520 9916Y $178.70 each


BJ60PFP50 05021312005823 A7520 9916Y $178.70 each


BJ60PFP45 05021312005816 A7520 9916Y $178.70 each

Flextend Pediatric trach tube, 4.0 mm ID, 6.0 mm OD, 41 mm length

BJ60PFP40 05021312005809 A7520 9916Y $178.70 each

Flextend Plus Pediatric trach tube, 3.5 mm OD, 4.3 mm OD, 40 mm length

BJ60PFP35 05021312005793 A7520 9916Y $178.70 each

Pediatric trach tube, cuffless 5.5 mm OD, 46 mm long

BJ60P055 05021312005786 A7520 9916Y $43.56 each

Pediatric trach tube, cuffless, size 5.0 BJ60P050 05021312005779 A7520 9916Y $43.56 each

Pediatric trach tube, cuffless 6.7 mm OD, 4.5 mm ID

BJ60P045 05021312005762 A7520 9916Y $43.56 each




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BillingCode MAC

Unit ofMeasure

Pediatric trach tube, cuffless 4 mm ID,6.0 mm OD

BJ60P040 05021312005755 A7520 9916Y $43.56 each

Pediatric trach tube, cuffless 3.5 mm ID, 5.3 mm OD

BJ60P035 05021312005748 A7520 9916Y $43.56 each

Pediatric trach tube, cuffless 3.0 mm ID, 4.7 mm OD

BJ60P030 05021312005731 A7520 9916Y $43.56 each

Pediatric trach tube, cuffless 2.5 mm ID, 4.0 mm OD, 38 mm length

BJ60P025 05021312005724 A7520 9916Y $67.29 each

Flextend neonatal trach tube, 4.0 mm ID, 6.0 mm OD

BJ60NFP40 05021312014740 A7520 9916Y $178.70 each

Flextend Plus neonatal trach tube, size 3.5 BJ60NFP35 05021312014733 A7520 9916Y $173.33 each

Flextend Plus neonatal trach tube, uncuffed, 3.0 mm ID, 4.7 mm OD, 32.00 mm distal length, 17.0 mm proximal length

BJ60NFP30 05021312014726 A7520 9916Y $173.33 each

Neonatal Trach tube, 4.0 mm ID, 36 mm long

BJ60N040 05021312005717 A7520 9916Y $43.56 each

Neonatal trach tube, cuffless, 3.5 mm ID, 34 mm long

BJ60N035 05021312005700 A7520 9916Y $43.56 each

Neonatal trach tube, cuffless, 3.0 mm ID, 4.7 mm OD, 32 mm long

BJ60N030 05021312005694 A7520 9916Y $43.56 each

Neonatal trach tube, cuffless, 2.5 mm ID, 30 mm long

BJ60N025 05021312005687 A7520 9916Y $67.29 each




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BillingCode MAC

Unit ofMeasure

Hyperflex fixed flange, x-large uncuffed trach tube, 7.0 mm

BJ60AFHXL70 05021312005648 A7520 9916Y $114.95 each

Hyperflex fixed-flange, extra length trach tube, 6.0 mm ID, 8.7 OD, 100.0 mm long

BJ60AFHXL60 05021312015631 A7520 9916Y $114.95 each

Adult trach tube, cuffless, all silicone,9.0 mm ID, 12.3 mm OD, 98 mm length

BJ60A190 05021312005588 A7520 9916Y $43.56 each


BJ60A180 05021312005571 A7520 9916Y $43.56 each


BJ60A170 05021312005564 A7520 9916Y $43.56 each

Adult trach tube, cuffless, all silicone,6.0 mm ID

BJ60A160 5021312005557 A7520 9916Y $43.56 each


BJ60A150 5021312005540 A7520 9916Y $43.56 each




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BillingCode MAC

Unit ofMeasure

Boston Medical – 4B

Singer Laryngectomy tube, size12 x 55 mm

BHSLT1255 0BHSLT1255 A7520 9916Y $72.60 each







Singer laryngectomy tube, size 10 x 27 mm BHSLT1027 0BHSLT1027 A7520 9916Y $72.60 each






Moore trach tube, extra-long standard length, size 8

BHMTT008 0BHMTT008 A7520 9916Y $187.55 each

Moore trach tube, extra-long standard length, size 6

BHMTT006 0BHMTT006 A7520 9916Y $187.55 each

Safe-t-tube Montgomery, standard, 12 mm, clear trach tube

BH420012 00BH420012 A7520 9916Y $193.60 each

Safe-t-tube Montgomery, standard, 10 mm, clear trach tube

BH420010 00BH420010 A7520 9916Y $193.60 each




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BillingCode MAC

Unit ofMeasure

Montgomery long term cannula set, size 10, fits stoma 49-57 mm long

BH331057 00BH331057 A7520 9916Y $127.05 each


BH331041 00BH331041 A7520 9916Y $127.05 each


BH331033 00BH331033 A7520 9916Y $127.05 each


BH331025 00BH331025 A7520 9916Y $127.05 each


BH330849 00BH330849 A7520 9916Y $127.05 each

Montgomery long term cannula set, size 8 fits stoma 25-33 mm long

BH330833 00BH330833 A7520 9916Y $127.05 each


BH330825 00BH330825 A7520 9916Y $127.05 each


BH330665 00BH330665 A7520 9916Y $127.05 each




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BillingCode MAC

Unit ofMeasure


BH330649 00BH330649 A7520 9916Y $127.05 each


BH330633 00BH330633 A7520 9916Y $127.05 each


BH330625 00BH330625 A7520 9916Y $127.05 each

Montgomery short term cannula set, size 6 BH330601 00BH330601 A7520 9916Y $114.95 each


BH330425 00BH330425 A7520 9916Y $127.05 each

Tracoe twist cuffless trach tube system, size 6

BH30306 00BH30306 A7520 9916Y $66.55 each

Tracoe comfort trach tube system, size 9 BH2059 0000BH2059 A7520 9916Y $306.13 each

Tracoe comfort trach tube system, size 8 BH20508 000BH20508 A7520 9916Y $306.13 each

Tracoe comfort trach tube system,extra-long length w/low profile inner cannula, size 7

BH20207 000BH20207 A7520 9916Y $234.74 each




mc sup prod trach a

22



BillingCode MAC

Unit ofMeasure

Tracoe comfort trach tube system,extra-long length w/low profile inner cannula, size 6

BH20206 000BH20206 A7520 9916Y $234.74 each

Tracoe comfort trach tube system,extra-long length w/o inner cannula, size 5

BH20105 000BH20105 A7520 9916Y $152.46 each

Tracoe comfort trach tube system, standard length w/ 15 mm poly adapter, size 7

BH10507 000BH10507 A7520 9916Y $227.48 each

Tracoe comfort trach tube system, standard length w/ 15 mm poly adapter, size 6

BH10506 000BH10506 A7520 9916Y $227.48 each

Tracoe trach tube one swivel valve, size 12 BH10412 000BH10412 A7520 9916Y $337.59 each

Tracoe trach tube, standard w/swivel valve, non-fenes, size 7

BH10407NF 0BH10407NF A7520 9916Y $337.59 each



Tracoe trach tube w/silver speaking valve, size 8

BH10308 000BH10308 A7520 9916Y $494.89 each

Dale Medical – 2Y

Trach tube holder extension (attachment for 240)

DA243 DA243 A7526 9917U $1.45 each

Trach tube holder for neonate - infant DA242 H84102421 A7526 9917U $2.54 each

Trach neckband, two-piece padded w/stretch panel, 1" wide band

DA240 H84102401 A7526 9917U $2.78 each




medical supply products: tracheostomy – a thru f manufacturers

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