Xeroform™ Occlusive Petrolatum Gauze

Reimbursement Information

Order Code Description HCPCS* HRI/NDC**
8884431302 Xeroform™ Occlusive Petrolatum Gauze Strip, Overwrap, 1" x 8" (2.5 cm x 20.3 cm) A6222 08080-4313-02
8884431605 Xeroform™ Occlusive Petrolatum Gauze Strip, Overwrap, 5" x 9" (12.7 cm x 22.9 cm) A6223 08080-4316-05
8884432000 Xeroform™ Occlusive Petrolatum Gauze Roll, 4" x 9' (10.2 cm x 2.7 m) A6224 08080-4320-00
8884433301 Xeroform™ Occlusive Petrolatum Gauze Patch, 1" x 8" (2.5 cm x 20.3 cm) A6222 08080-4333-01
8884433400 Xeroform™ Occlusive Petrolatum Gauze Patch, 2" x 2" (5.1 cm x 5.1 cm) A6222 08080-4334-01
8884433500 Xeroform™ Occlusive Petrolatum Gauze Patch, 4" x 4" (10.2 cm x 10.2 cm) A6222 08080-4335-01
8884433605 Xeroform™ Occlusive Petrolatum Gauze Strip, 5" x 9" (12.7 cm x 22.9 cm) A6223 08080-4336-05

* DISCLAIMER: The Centers for Medicare and Medicaid Services was the primary source of any HCPCS information contained on this website. Covidien does not represent or guarantee that any HCPCS information contained on this website is complete, accurate, or applicable to any particular patient or third-party payer and disclaims all liability for any consequence resulting from any reliance on such information. The final billing-related decisions for any product must be made by the health care provider considering the medical necessity of the product furnished as well as the requirements of third-party payers and any local, state, or federal laws and regulations that apply to the product furnished. Covidien is providing this information in an educational capacity with the understanding that Covidien is not engaged in rendering legal, accounting, or other professional services. Covidien encourages all health care providers to consult with their own advisors regarding coding and payment.

** The codes included in the “HRI/NDC” column are Health Related Item (or “HRI”) codes for medical devices and National Drug Codes (or “NDC”) for pharmaceutical products.