| | For the treatment of diarrhea associated with: |
| 110 | An ileostomy or a colostomy;. |
| | LU Authorization Period: 1 year |
| 111 | Bowel resection, including short bowel syndrome; |
| | LU Authorization Period: 1 year |
| 112 | Inflammatory Bowel Diseases, i.e. Crohn's Disease and Ulcerative Colitis; |
| | LU Authorization Period: 1 year |
| 113 | Cancer, including chemotherapy or radiation therapy; |
| | LU Authorization Period: 1 year |
| 114 | HIV/AIDS; |
| | LU Authorization Period: 1 year |
| 115 | Acute diarrhea in patients in congregated housing, i.e. Long Term Care Facilities (LTCF), or for patients receiving Home Care; |
| | LU Authorization Period: 1 year |
| 224 | Fecal incontinence. |
| | LU Authorization Period: 1 year |
