Summary & Overview

HCPCS A4376: Ostomy Pouch, Drainable with Faceplate, Rubber

HCPCS Level II code A4376 represents a rubber, drainable ostomy pouch with an attached faceplate, billed per each pouch. This supply code is central to post-operative and chronic ostomy management and affects durable medical equipment (DME) coverage, home health supply delivery, and outpatient wound and ostomy services across the country. Nationally, ostomy pouching supplies are a routine, ongoing cost for patients with intestinal or urinary stomas and are relevant to payers, clinicians, and supply chain administrators.

Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what A4376 denotes, typical settings where the item is used, and which payers commonly handle claims for these supplies. The publication also outlines the kinds of benchmarks and policy topics that routinely accompany ostomy supply codes, including coverage criteria, supply limits, and billing practices. Where available, readers will see comparative reimbursement benchmarks and common administrative considerations for billing and claim adjudication. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA4376HCPCS Level IIostomy suppliesdurable medical equipmentwound and ostomy carehome healthoutpatient supplies

Billing Code Overview

HCPCS Level II code A4376 describes an ostomy pouch, drainable, with faceplate attached, rubber, each. The service type is durable medical equipment (ostomy supplies) intended for management of stomas and collection of effluent. The typical site of service is outpatient or home use where patients apply and change ostomy pouches as part of ongoing ostomy care.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 68-year-old with a permanent end colostomy following colorectal cancer resection who requires routine ostomy pouch supplies. The service described by A4376 is the provision of a rubber drainable ostomy pouch with a faceplate attached. In clinical workflow, a wound, ostomy and continence (WOC) nurse or home health clinician evaluates the stoma and peristomal skin, documents fit and leakage issues, and orders ostomy supplies. The supplier dispenses the A4376 pouch to the patient in an outpatient medical supply setting or via home delivery. Documentation includes the prescription or supplier order, stoma assessment, pouch type and size, frequency of change, and payer/coverage authorization when required. Typical encounters occur in outpatient clinics, home health visits, skilled nursing facilities, and medical supply pharmacies when replacing or resupplying an existing ostomy system.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier.	Standard reporting when no special circumstances apply.
`62`	Two surgeons.	When two surgeons share responsibility for care related to complex stoma revision or concurrent procedures that necessitate specialized pouching decisions.
`52`	Reduced services.	If a partial supply is provided (e.g., fewer pouches than typical ordered) or delivery/service is curtailed.
`53`	Discontinued procedure.	Rarely used for supplies; when an ordered supply delivery is cancelled after initiation of furnishing process.
`78`	Unplanned return to operating room.	Relevant when ostomy supplies are provided in context of an unplanned re-operation requiring different pouching needs (billing coordination).
`80`	Assistant surgeon.	When an assistant surgeon is involved in a stoma-related operative service influencing supply selection.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services.	When an advanced practice clinician provides the stoma assessment and issues the supply order under their own NPI.
`NU`	New equipment.	If this pouch represents initial provision of a new ostomy system type to the patient.
`QX`	Modifier certifying two-person surgical assistant.	When two individuals serve as surgical assistants in a procedure that changes ostomy supply needs.
`QY`	One-person surgical assistant.	When a single surgical assistant affects the operative plan and subsequent supply needs.

Taxonomy Code	Specialty	Notes
367500000X	Wound Care Nurse / Ostomy Care	Wound, Ostomy and Continence (WOC) nurses evaluate stomas and order supplies.
207Q00000X	Family Medicine	Primary care clinicians frequently coordinate durable medical equipment and supplies for chronic ostomy patients.
207R00000X	General Surgery	Surgeons performing ostomy creation and revisions influence pouch type selection.
363L00000X	Home Health Agency	Providers who deliver and educate patients on ostomy supplies in the home setting.
174400000X	Gastroenterology	Gastroenterologists manage underlying disease and coordinate ostomy care in some patients.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K90.2`	Maldigestion due to exocrine pancreatic insufficiency.	Patients with chronic gastrointestinal dysfunction may have ostomies and require specific pouching supplies for effluent management.
`K63.1`	Perforation of intestine (nontraumatic).	Intestinal perforation can lead to emergent resection and subsequent ostomy creation requiring long-term pouch supplies.
`C18.9`	Malignant neoplasm of colon, unspecified.	Colorectal cancer resection often necessitates a colostomy or ileostomy, creating ongoing need for `A4376` drainable pouches.
`K91.82`	Postoperative intestinal obstruction.	Postoperative complications can lead to temporary or permanent ostomy and need for appropriate pouches.
`N32.89`	Other specified disorders of bladder.	Some complex pelvic surgeries affecting bladder and bowel may result in diversionary ostomies and supply needs.
`Z43.3`	Encounter for attention to stoma of large intestine.	Used for routine follow-up and supply management of colostomy stomas, directly relevant to ordering `A4376`.
`Z93.3`	Colostomy status.	Status code indicating presence of a colostomy; directly supports medical necessity for pouch supplies.
`Z93.2`	Ileostomy status.	Status code indicating presence of an ileostomy; supports ongoing need for drainable ostomy pouches.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44320`	Enterostomy, e.g., ileostomy or colostomy, creation of exterior intestinal stoma; simple.	Surgical procedure that results in need for ostomy pouching systems such as `A4376` for ongoing management.
`49440`	Removal of percutaneous gastrostomy tube; simple, with replacement if performed.	Occurs in patients with enteric diversion or combined feeding access; ostomy supply needs may be coordinated when enterostomy devices are managed.
`97597`	Debridement of open wound(s), selective debridement without anesthesia (first 20 sq cm or less).	Peristomal skin breakdown may require wound care debridement and evaluation that informs pouch selection and frequency of change.
`97750`	Physical performance test or measurement with instrumentation.	Used less commonly; pelvic floor or abdominal wall assessment may be performed in ostomy rehabilitation clinics that also supply pouches.
`99070`	Supplies and materials, noncovered by the procedure, additional to service.	Often used when additional non-covered ostomy supplies or accessories are furnished alongside `A4376`.