Summary & Overview
HCPCS Level II A4407: Ostomy Skin Barrier with Flange, Extended Wear
HCPCS Level II code A4407 designates an ostomy skin barrier with flange, extended wear, and built-in convexity sized 4 x 4 inches or smaller. This supply is a component of ostomy management, supporting peristomal skin protection and appliance adhesion for patients requiring stoma care. Nationally, ostomy supplies like this are significant for postoperative and chronic ostomy management, impacting durable medical equipment coverage, patient access to supplies, and clinical outcomes related to skin integrity.
Major commercial payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find a concise explanation of what the code represents, the clinical context for its use, and how it fits within durable medical equipment billing for ostomy supplies. The publication outlines typical sites of service and payer relevance, and provides guidance on common documentation and billing considerations where available. When input data is not provided, the text notes that "Data not available in the input." This piece does not provide provider recommendations but focuses on clarifying the code purpose, service classification, and the aspects of coverage and billing practices that national stakeholders track for ostomy supply reimbursement and policy alignment.
Billing Code Overview
HCPCS Level II code A4407 describes an ostomy skin barrier with flange (solid, flexible, or accordion), extended wear, with built-in convexity, sized 4 x 4 inches or smaller, each. This item is classified under Durable Medical Equipment / Ostomy Supplies and is intended to protect peristomal skin and secure ostomy appliances for patients with stomas.
Typical site of service: Office (POS 11).
Clinical & Coding Specifications
Clinical Context
A patient with an ostomy (colostomy, ileostomy, or urostomy) presents to an outpatient clinic (Office POS 11) for replacement of an ostomy skin barrier. The barrier required is a small flange-style, extended-wear skin barrier with built-in convexity measuring 4 x 4 inches or smaller. The clinical workflow typically includes: a focused assessment of the peristomal skin and stoma output; selection and fitting of the appropriate ostomy skin barrier product; education on application and wear time; and documentation of the medical necessity for an extended-wear, built-in-convexity barrier (e.g., peristomal skin irritation, retracted stoma, or frequent leakage). The product is supplied as Durable Medical Equipment / ostomy supplies and billed using HCPCS Level II code A4407 with appropriate modifier(s) based on acquisition status (e.g., new equipment or rental) and medical policy requirement flags.
Coding Specifications
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Modifiers
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NU- New EquipmentUse when the ostomy skin barrier is being provided as new, first-time equipment to the beneficiary.
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RR- RentalUse when the supplier is billing for the item as a rental per payer rental policies.
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KX- Requirements specified in the medical policy have been metUse when documentation exists that the payer-specific medical policy conditions for coverage are satisfied.
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Associated provider taxonomies
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207X00000X— Orthopedic SurgeryRepresents orthopedic surgeons; listed as an associated taxonomy in the input.
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225100000X— Physical TherapistRepresents licensed physical therapists; listed as an associated taxonomy in the input.
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225200000X— Occupational TherapistRepresents licensed occupational therapists; listed as an associated taxonomy in the input.
Related Diagnoses
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S52.501A— Unspecified fracture of the lower end of right radius, initial encounter for closed fractureRelevant when a patient with an upper extremity fracture has concurrent ostomy needs or is seen in the same outpatient setting where durable medical equipment, including ostomy supplies, is managed. The diagnosis documents a current orthopedic injury.
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S82.101A— Unspecified fracture of upper end of right tibia, initial encounter for closed fractureRelevant when a patient with a lower extremity fracture receives outpatient care that may include provision of durable medical equipment; documents a current lower extremity injury.
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M25.511— Pain in right shoulderRelevant as a musculoskeletal complaint that may accompany patients seen in outpatient clinics providing DME and related services; documents a pain symptom.
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M25.561— Pain in right kneeRelevant as a musculoskeletal complaint that may be addressed in the same outpatient care episode where DME or supplies are dispensed; documents a pain symptom.
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S93.401A— Sprain of unspecified ligament of right ankle, initial encounterRelevant when patients present with an ankle sprain in the outpatient setting; documents a current lower extremity soft tissue injury and may coincide with other DME needs.
Related Codes
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29125— Application of short arm splint (forearm to hand); staticRelated as an example of a splint application procedure used for upper extremity immobilization in the same clinical setting where durable medical equipment and supplies are managed. May be billed separately when splint application is performed.
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29130— Application of finger splint; staticRelated as another example of a splint-related service that may be provided in the same clinic visit and billed separately when performed.
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29515— Application of short leg splint (calf to foot)Related as an example of lower extremity immobilization procedures provided in outpatient settings where ostomy supplies might also be dispensed; billed separately when performed.
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97760— Orthotic management and training, upper extremity(s), lower extremity(s) and/or trunk, each 15 minutesRelated as a therapy service that addresses orthotic/assistive device management and training; may be billed in conjunction with durable medical equipment supply when documented training or management is provided.
Notes: These related procedure codes are presented as associated services; they are commonly used together in multidisciplinary outpatient workflows or billed separately as clinically indicated. The primary supply is billed with HCPCS Level II code A4407.
National Reimbursement Benchmarks
Across national benchmarks, Medicare and BUCA (average commercial) share the same mean rate of $30.49 for HCPCS Level II code A4407, while commercial payers vary widely — Blue Cross Blue Shield reports a substantially higher mean at $61.99 compared with Aetna ($6.22), Cigna Health ($7.36), and UnitedHealthcare ($7.53). The national landscape therefore shows Medicare/average commercial clustering at $30.49 with notable outliers among large commercial plans.
Rate dispersion (P75 minus P25) is tightest for Cigna Health (0.00) and relatively tight for UnitedHealthcare (2.50) and Aetna (3.50). The widest dispersion appears for Blue Cross Blue Shield (3.00) and BUCA/Medicare (3.50). The table and chart below present the full breakdown of mean rates and percentiles for each payer.
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