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Prolapse Pessaries
1st and 2nd degree
3rd degree

Stress Urinary Incontinence /Incompetent Cervix
Cystocele and Retrocele
Incompetent Cervix

Incontinence
Incontinence Pessaries and Devices

Pessaries

Uterine Prolapse

1st and 2nd degree

  • Ring
  • Ring with support
  • Shaatz
  • Regula

3rd degree

  • Donut
  • Cube
  • Tandem Cube
  • Inflatoball
  • Gellhorn

Retrodisplacement

  • Smith
  • Hodge
  • Risser

Cystocele and/or Retrocele

  • Gehrung

Incompetent Cervix

  • Hodge

Incontinence Pessaries and Devices

  • Ring Incontinence Pessary
  • Incontinence Dish
  • Incontinence Dish with Support
  • Ring with Support and Knob
  • Ring with knob
  • Hodge
  • Hodge with Support
  • Gehrung with Knob
  • Kegel Kones
  • Kegel Exersizer

MEDICARE REIMBURSEMENT FOR PESSARIES (HCPCS)

  High Low
A4562 All Non-Rubber Pessaries $53.11 $44.25
A4561 Rubber Pessaries including latex $19.00 $16.00
(Reimbursement figures based on national average. May vary depending on region of country))

DIAGNOSTIC CODES (ICD-9-CM) 2002

  Code
Prolapse  
Cystocle 618.0
Uterovagina 618.4
   Complete 618.3
   Incomplete 618.2
Uterus (1st, 2nd, 3rd Degree)
Without Vaginal Wall Prolapse
618.1
 
Vaginal Wall Prolapse
Without Uterine Prolapse
618.0
With Uterine Prolapse 618.4
   Complete 618.3
   Imcomplete 618.2
   Post Hysterectomy 618.5
 
Incontinence 618.5
Stress Urinary incontinence 625.6
Urge and Stress Incontinence 788.33
 
Incompetent Cervix 654.5
 
CPT (PROCEDURE) CODES  
 
Fitting and Insertion of Pessary 57160


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