Xeroform Occlusive Petrolatum Gauze

Last updated on 1/29/25 | First published on 1/29/25 | Literature review current through Jan. 2025 [cite]

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Technology and Product Assessment

Product Type: Antimicrobial

Unbiased information for educational purposes only. WoundReference does not produce, market, advertise, re-sell or distribute healthcare goods or services consumed by, or used on patients. For information about specific products, please contact the manufacturer directly.

Xeroform Occlusive Petrolatum Gauze is an antimicrobial gauze wound dressing.

INTENDED USES: Xeroform Occlusive Petrolatum Gauze helps protect and promote moist wound healing.

CLAIMED BENEFITS: 3% bismuth tribromophenate in a special petrolatum blend on fine mesh gauze. Non-adherent. Clings and conforms to body contours. Not made with natural rubber latex.

Manufacturer: Cardinal Health

Information retrieved from manufacturer and/or FDA-approved labels

* Wound Reference does not produce, market, re-sell or distribute health care goods or services consumed by, or used on, patients. The product information contained on this page, including the product images and additional product materials, was collected from various supplier sources. All product claims and specifications are those of the product suppliers. Every effort has been made to ensure the accuracy of the product information, however on occasion manufacturers may alter their products or packaging without notice. Wound Reference assumes no liability for inaccuracies or misstatements about products. The properties of a product may change or be inaccurate following the posting or printing of the product information in the document, either in the print or online version. Due to product changes, information listed in this document is subject to change without notice. We recommend that you always read labels, warnings and instructions for use before using a product. Content on this site is for reference purposes and is not intended to be a substitute for professional advice given by a physician or other licensed healthcare professional.

ESSENTIALS

Product

Estimated
Out-of-pocket
Cost

HCPCS Class

HCPCS

Xeroform Occlusive Petrolatum Gauze, 1 in. x 8 in., box of 50

Xeroform Occlusive Petrolatum Gauze, 5 in. x 9 in., box of 50

Xeroform Occlusive Petrolatum Gauze, 4 in. x 3 yd., box of 6

Xeroform Occlusive Petrolatum Gauze, 1 in. x 8 in., box of 50

Xeroform Occlusive Petrolatum Gauze, 2 in. x 2 in., box of 25

Xeroform Occlusive Petrolatum Gauze, 4 in. x 4 in., box of 25

Xeroform Occlusive Petrolatum Gauze, 5 in. x 9 in., box of 50

* Hover on the information button next to each header for detailed explanation on the type of information provided by the table

Select your state for Medicare
DME coverage and co-payment

Product

Estimated
Out-of-pocket
Cost

Patient DME Co-Payment per Billable Unit

DME Reimbursement to Suppliers

Frequency Replacement if Requirements Met

Office and/or Facility - Product reimbursement

Cardinal Health
Xeroform Occlusive Petrolatum Gauze, 1 in. x 8 in., box of 50

$.00

Coming soon

Cardinal Health
Xeroform Occlusive Petrolatum Gauze, 5 in. x 9 in., box of 50

$.00

Coming soon

Cardinal Health
Xeroform Occlusive Petrolatum Gauze, 4 in. x 3 yd., box of 6

$.00

Coming soon

Cardinal Health
Xeroform Occlusive Petrolatum Gauze, 1 in. x 8 in., box of 50

$.00

Coming soon

Cardinal Health
Xeroform Occlusive Petrolatum Gauze, 2 in. x 2 in., box of 25

$.00

Coming soon

Cardinal Health
Xeroform Occlusive Petrolatum Gauze, 4 in. x 4 in., box of 25

$.00

Coming soon

Cardinal Health
Xeroform Occlusive Petrolatum Gauze, 5 in. x 9 in., box of 50

$.00

Coming soon

* Every effort has been made to ensure the accuracy of the product information, however you should visit the manufacturer's website for the latest information.

* Hover on the information button next to each header for detailed explanation on the type of information provided by the table

Product

Estimated
Out-of-pocket
Cost

Recom / Evidence

FDA Safety

Quality Measures

Cost Effectiveness

Xeroform Occlusive Petrolatum Gauze, 1 in. x 8 in., box of 50

Coming soon

Xeroform Occlusive Petrolatum Gauze, 5 in. x 9 in., box of 50

Coming soon

Xeroform Occlusive Petrolatum Gauze, 4 in. x 3 yd., box of 6

Coming soon

Xeroform Occlusive Petrolatum Gauze, 1 in. x 8 in., box of 50

Coming soon

Xeroform Occlusive Petrolatum Gauze, 2 in. x 2 in., box of 25

Coming soon

Xeroform Occlusive Petrolatum Gauze, 4 in. x 4 in., box of 25

Coming soon

Xeroform Occlusive Petrolatum Gauze, 5 in. x 9 in., box of 50

Coming soon

Product

Estimated
Out-of-pocket
Cost

Features

Xeroform Occlusive Petrolatum Gauze, 1 in. x 8 in., box of 50

Xeroform Occlusive Petrolatum Gauze, 5 in. x 9 in., box of 50

Xeroform Occlusive Petrolatum Gauze, 4 in. x 3 yd., box of 6

Xeroform Occlusive Petrolatum Gauze, 1 in. x 8 in., box of 50

Xeroform Occlusive Petrolatum Gauze, 2 in. x 2 in., box of 25

Xeroform Occlusive Petrolatum Gauze, 4 in. x 4 in., box of 25

Xeroform Occlusive Petrolatum Gauze, 5 in. x 9 in., box of 50

No CPT codes to display.

Hover on the information button next to each header for detailed explanation on the type of information provided by the table
The information provided on this website is informational only. This is not a guarantee of Reimbursement Rates, nor is it intended to make recommendations regarding clinical practices. Information on this website is subject to change with out notice due to changes in reimbursement laws, regulations, rules and policies. The ultimate responsibility for correct coding lies with the provider of services. Please contact the appropriate payer for their interpretation of the appropriate code to use for the procedure.
CPT® is a registered trademark of the American Medical Association. All CPT codes and descriptions are copyrighted 2018, American Medical Association. All rights reserved. CPT codes and CPT descriptions are from the current manuals and those included herein are not intended to be all-inclusive and are included for informational purposes only. Codes referenced on Wound Reference are for informational purposes only. Inclusion or exclusion of any codes does not guarantee coverage. Providers should reference the American Medical Association prior to the submission of claims for reimbursement of covered services.

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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

Topic 2896 Version 1.0

Xeroform Occlusive Petrolatum Gauze

Xeroform Occlusive Petrolatum Gauze

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