Summary & Overview

HCPCS A4361: Ostomy Faceplate, Each

HCPCS Level II code A4361 covers an ostomy faceplate, the adhesive-mounted flange component of an ostomy pouching system. Ostomy faceplates are clinically essential supplies for patients with ileostomies, colostomies, or urostomies to protect peristomal skin and secure external collection pouches. Nationally, ostomy supplies represent a steady component of durable medical equipment and home health spending due to long-term patient dependence and recurring replacement needs. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for A4361, payer coverage considerations, and commonly observed billing practices and modifiers (where applicable). The publication summarizes reimbursement benchmarks and utilization patterns for ostomy faceplates, highlights relevant documentation and supply-delivery settings, and outlines common administrative challenges encountered in claims adjudication. Data not available in the input is noted where applicable. This resource is intended to inform billing staff, DME suppliers, and payer policy analysts about the role of HCPCS Level II code A4361 in ostomy supply management and revenue cycle workflows.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA4361HCPCSOstomy SupplyDurable Medical EquipmentHome HealthOstomy ManagementMedical BillingRevenue Cycle

Billing Code Overview

HCPCS Level II code A4361 denotes an ostomy faceplate, each. This supply is used as the adhesive-mounted flange component of an ostomy pouching system that secures the pouch to the skin around a stoma.

Service type: Ostomy supply
Typical site of service: Durable medical equipment or home medical supply setting; used by patients in the home with ostomies and provided via outpatient DME suppliers or home health supply channels.

Clinical & Coding Specifications

Clinical Context

A patient with a permanent colostomy presents to a durable medical equipment (DME) supplier for routine replacement of a single-piece ostomy faceplate because the existing faceplate is worn, leaking, or causing peristomal skin irritation. The patient is a community-dwelling adult who self-manages ostomy supplies but requires ordering through a DME provider for coverage and secure fitting. The clinical workflow begins with a clinician (wound/ostomy nurse or primary care provider) documenting the need for a replacement faceplate and an appropriate diagnosis such as a colostomy or ileostomy. The patient or clinician submits a prescription to the DME supplier specifying A4361 for an ostomy faceplate, quantity, and frequency. The DME supplier verifies payer coverage (for example, Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare), obtains any required prior authorization, and dispenses the product. Nursing or DME staff provide brief education on application, inspection of the stoma and peristomal skin, and recommendations for follow-up with the ostomy nurse or physician if there are signs of complications such as persistent leakage, skin breakdown, or stenosis. Documentation includes the prescription, product description (A4361), quantity dispensed, date of service, patient identifiers, and clinical justification in the medical record.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	Used when no special modifier applies and the item is billed as usual.
`11`	Primary procedure	Not typically applied to DME items; used when this supply is the primary billed service if policy requires.
`22`	Increased procedural services	Rare for DME; used if extraordinary effort related to fitting is documented and allowed by payer.
`52`	Reduced services	Used if a partial faceplate is supplied or service is less than documented/anticipated.
`53`	Discontinued procedure	Applied if an order is canceled after initiation of processing and payer permits.
`54`	Surgical care only	Not commonly used for supplies; may apply when surgical team bills separately from postoperative DME.
`55`	Postoperative management only	Used when supplier provides only postoperative supplies under global surgical billing rules if accepted by payer.
`62`	Two surgeons	Uncommon for DME; included when two practitioners share responsibility and payer allows modifier on supply claims.
`78`	Return to OR for related procedure by same surgeon	Not typical for DME claims; rarely used if supply billing ties to an inpatient surgical revision event.
`80`	Assistant surgeon	Not typically applicable to DME; included when assistant billing affects global reimbursement treatment per payer rules.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare	Used when an advanced practice clinician furnishes the associated evaluation and documentation required for coverage.
`CO`	Items provided by a contracted organization	Used when a contracted supplier relationship affects billing per payer contracts.
`NU`	New equipment	Use when the faceplate is initial issuance as new equipment rather than refitting or replacement under different benefits.
`RR`	Recovery room	Applied when item use is associated with recovery room services if payer policies require location-specific modifiers.

Taxonomy Code	Specialty	Notes
`252W00000X`	Wound Care Nurse (Enterostomal Therapist)	Specialized in ostomy care, performs fitting and education.
`207Q00000X`	Family Medicine	Primary care clinicians who manage chronic ostomy supplies and write prescriptions.
`207L00000X`	General Surgery	Surgeons who create and manage ostomies and provide postoperative orders for supplies.
`363A00000X`	Durable Medical Equipment Supplier	Supplier specialty that dispenses `A4361` and coordinates billing.
`261QM2400X`	Nurse Practitioner	Advanced practice clinicians who evaluate and prescribe ostomy supplies.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K90.2`	Short bowel syndrome	Patients with significant intestinal resection may have ostomies requiring faceplates.
`Z43.2`	Encounter for attention to other artificial openings of digestive tract	Directly related to ongoing management and supplies for an ostomy.
`K63.5`	Polyp of colon	Underlying colorectal disease that can lead to surgical resection and ostomy formation.
`C18.9`	Malignant neoplasm of colon, unspecified	Colorectal cancer often necessitates colostomy and long-term ostomy supplies.
`K91.2`	Postsurgical malabsorption	Postoperative conditions in patients with ostomies affecting nutritional management and supply needs.
`L89.9`	Pressure ulcer, unspecified	Peristomal skin breakdown or pressure injuries that influence choice and frequency of faceplate replacement.
`K31.9`	Disease of stomach and duodenum, unspecified	Included as a gastrointestinal diagnosis that can be part of complex surgical histories leading to ostomy care.
`N18.9`	Chronic kidney disease, unspecified	Common comorbidity affecting fluid balance and stoma output, relevant to selection of ostomy supplies.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45330`	Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)	Performed in evaluation of lower GI conditions leading to colostomy creation; documented history may support ongoing need for ostomy supplies.
`44320`	Closure of ileostomy or colostomy	Surgical code for reversal; relevant as a future procedure that would change long-term ostomy supply needs.
`49560`	Initial repair of parastomal hernia or stoma complication	Surgery for stoma complications; documentation of such procedures can affect necessity and type of ostomy faceplate.
`99401`	Preventive medicine counseling visit, individual; approximately 15 minutes	Patient education sessions by clinician or ostomy nurse on stoma care and proper use of `A4361` faceplate.
`97760`	Orthotic and prosthetic management and training, initial encounter	Analogous service code for training on use of medical appliances; used when extensive supplier or therapist training is provided alongside supply dispensation.