HCPCS Range Ostomy Pouches and Supplies

• 1 Ostomy faceplate, each ( A4361 )

• 2 Skin barrier; solid, 4 x 4 or equivalent; each ( A4362 )

• 3 Ostomy clamp, any type, replacement only, each ( A4363 )

• 4 Adhesive, liquid or equal, any type, per oz ( A4364 )

• 5 Ostomy vent, any type, each ( A4366 )

• 6 Ostomy belt, each ( A4367 )

• 7 Ostomy filter, any type, each ( A4368 )

• 8 Ostomy skin barrier, liquid (spray, brush, etc), per oz ( A4369 )

• 9 Ostomy skin barrier, powder, per oz ( A4371 )

• 10 Ostomy skin barrier, solid 4x4 or equivalent, standard wear, with built-in convexity, each ( A4372 )

• 11 Ostomy skin barrier, with flange (solid, flexible or accordian), with built-in convexity, any size, each ( A4373 )

• 12 Ostomy pouch, drainable, with faceplate attached, plastic, each ( A4375 )

• 13 Ostomy pouch, drainable, with faceplate attached, rubber, each ( A4376 )

• 14 Ostomy pouch, drainable, for use on faceplate, plastic, each ( A4377 )

• 15 Ostomy pouch, drainable, for use on faceplate, rubber, each ( A4378 )

• 16 Ostomy pouch, urinary, with faceplate attached, plastic, each ( A4379 )

• 17 Ostomy pouch, urinary, with faceplate attached, rubber, each ( A4380 )

• 18 Ostomy pouch, urinary, for use on faceplate, plastic, each ( A4381 )

• 19 Ostomy pouch, urinary, for use on faceplate, heavy plastic, each ( A4382 )

• 20 Ostomy pouch, urinary, for use on faceplate, rubber, each ( A4383 )

• 21 Ostomy faceplate equivalent, silicone ring, each ( A4384 )

• 22 Ostomy skin barrier, solid 4x4 or equivalent, extended wear, without built-in convexity, each ( A4385 )

• 23 Ostomy pouch, closed, with barrier attached, with built-in convexity (1-piece), each ( A4387 )

• 24 Ostomy pouch, drainable, with extended wear barrier attached, (1-piece), each ( A4388 )

• 25 Ostomy pouch, drainable, with barrier attached, with built-in convexity (1-piece), each ( A4389 )

• 26 Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1-piece), each ( A4390 )

• 27 Ostomy pouch, urinary, with extended wear barrier attached (1-piece), each ( A4391 )

• 28 Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1-piece), each ( A4392 )

• 29 Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1-piece), each ( A4393 )

• 30 Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce ( A4394 )

• 31 Ostomy deodorant for use in ostomy pouch, solid, per tablet ( A4395 )

• 32 Ostomy belt with peristomal hernia support ( A4396 )

• 33 Ostomy irrigation supply; bag, each ( A4398 )

• 34 Ostomy irrigation supply; cone/catheter, with or without brush ( A4399 )

• 35 Ostomy irrigation set ( A4400 )

• 36 Lubricant, per ounce ( A4402 )

• 37 Ostomy ring, each ( A4404 )

• 38 Ostomy skin barrier, non-pectin based, paste, per ounce ( A4405 )

• 39 Ostomy skin barrier, pectin-based, paste, per ounce ( A4406 )

• 40 Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each ( A4407 )

• 41 Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each ( A4408 )

• 42 Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each ( A4409 )

• 43 Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each ( A4410 )

• 44 Ostomy skin barrier, solid 4x4 or equivalent, extended wear, with built-in convexity, each ( A4411 )

• 45 Ostomy pouch, drainable, high output, for use on a barrier with flange (2-piece system), without filter, each ( A4412 )

• 46 Ostomy pouch, drainable, high output, for use on a barrier with flange (2-piece system), with filter, each ( A4413 )

• 47 Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each ( A4414 )

• 48 Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4x4 inches, each ( A4415 )

• 49 Ostomy pouch, closed, with barrier attached, with filter (1-piece), each ( A4416 )

• 50 Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1-piece), each ( A4417 )

• 51 Ostomy pouch, closed; without barrier attached, with filter (1-piece), each ( A4418 )

• 52 Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2-piece), each ( A4419 )

• 53 Ostomy pouch, closed; for use on barrier with locking flange (2-piece), each ( A4420 )

• 54 Ostomy supply; miscellaneous ( A4421 )

• 55 Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each ( A4422 )

• 56 Ostomy pouch, closed; for use on barrier with locking flange, with filter (2-piece), each ( A4423 )

• 57 Ostomy pouch, drainable, with barrier attached, with filter (1-piece), each ( A4424 )

• 58 Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2-piece system), each ( A4425 )

• 59 Ostomy pouch, drainable; for use on barrier with locking flange (2-piece system), each ( A4426 )

• 60 Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2-piece system), each ( A4427 )

• 61 Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1-piece), each ( A4428 )

• 62 Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1-piece), each ( A4429 )

• 63 Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1-piece), each ( A4430 )

• 64 Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1-piece), each ( A4431 )

• 65 Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2-piece), each ( A4432 )

• 66 Ostomy pouch, urinary; for use on barrier with locking flange (2-piece), each ( A4433 )

• 67 Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2-piece), each ( A4434 )

• 68 Ostomy pouch, drainable, high output, with extended wear barrier (1-piece system), with or without filter, each ( A4435 )

• 69 Irrigation supply; sleeve, disposable, per month ( A4437 )

• 70 Irrigation supply; sleeve, reusable, per month ( A4436 )

• 71 Adhesive clip applied to the skin to secure external electrical nerve stimulator controller, each ( A4438 )