Monarch Medical Products

The Cube pessary may be used to relieve the symptoms of a cystocele or rectocele, as well as, a second or third-degree uterine prolapse. Cube pessaries are available with or without drains.

HCPCS Reimbursement Code for Pessary - A4562
Code for Office Visit - 99214
CPT Code for Fitting & Insertion - 57160

SKU #	Description	Price
1615025	Cube Pessary Without Drains, 25mm #0	$45
1615029	Cube Pessary Without Drains, 29mm #1	$45
1615032	Cube Pessary Without Drains, 33mm #2	$45
1615037	Cube Pessary Without Drains, 37mm #3	$45
1615041	Cube Pessary Without Drains, 41mm #4	$45
1615045	Cube Pessary Without Drains, 45mm #5	$45
1615050	Cube Pessary Without Drains, 45mm #6	$45
1615055	Cube Pessary Without Drains, 55mm #7	$45
1615065	Cube Pessary Without Drains, 65mm #8	$45
1615070	Cube Pessary Without Drains, 70mm #9	$45
1615075	Cube Pessary Without Drains, 75mm #10	$45
1616025	Cube Pessary With Drains, 25mm #0	$45
1616029	Cube Pessary With Drains, 29mm #1	$45
1616032	Cube Pessary With Drains, 32mm #2	$45
1616037	Cube Pessary With Drains, 37mm #3	$45
1616041	Cube Pessary With Drains, 41mm #4	$45
1616045	Cube Pessary With Drains, 45mm #5	$45
1616050	Cube Pessary With Drains, 45mm #6	$45
1616055	Cube Pessary With Drains, 55mm #7	$45
1616065	Cube Pessary With Drains, 65mm #8	$45
1616070	Cube Pessary With Drains, 70mm #9	$45
1616075	Cube Pessary With Drains, 75mm #10	$45