Summary & Overview
HCPCS A4379: Urinary Ostomy Pouch with Faceplate, Plastic
HCPCS Level II code A4379 denotes a disposable urinary ostomy pouch with an attached faceplate, a common supply used by patients with urinary diversions. Nationally, this code represents a routine durable medical supply that affects home health management, outpatient wound and ostomy care, and supplier billing workflows. It matters because consistent coding ensures access to necessary supplies and supports accurate claims processing across multiple payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of payer coverage patterns, common billing practices, and benchmarking context for supply reimbursement. The publication provides clinical context for when the supply is used, typical sites of service, and the role of this supply in outpatient and home-based ostomy care. It also outlines common modifiers and administrative considerations provided in the input and notes when data elements are not available.
This summary equips clinicians, billing professionals, and policy analysts with an overview of HCPCS Level II code A4379, highlighting its relevance to continuity of care for patients with urinary ostomies and the administrative factors that influence coverage and claims handling nationally.
Billing Code Overview
HCPCS Level II code A4379 describes an ostomy pouch, urinary, with faceplate attached, plastic, each. This item is a disposable urinary ostomy appliance designed to collect urine from a urostomy; the service type is supply of a medical ostomy appliance. The typical site of service is outpatient or home-based care where patients manage urinary diversion supplies, including home health, outpatient clinics, or patient self-care at home.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a surgically created urinary stoma (urostomy) following cystectomy for invasive bladder cancer, neurogenic bladder with failed reconstruction, or severe trauma to the lower urinary tract. The patient presents to an outpatient durable medical equipment (DME) clinic, wound-ostomy-continence (WOC) nurse visit, or home health visit for ongoing stoma care and supply needs. The clinician assesses stoma integrity, peristomal skin condition, and current pouching system fit. When the existing pouching system requires replacement due to wear, leakage, or change in stoma size, a new ostomy urine pouch with an integrated faceplate is dispensed and documented using billing code A4379. Typical workflow includes verification of medical necessity, review of prior supplies, measurement of stoma, selection of appropriate flange/faceplate size, patient education on application and emptying, and documentation of diagnosis supporting urostomy care and supply need. Sites of service commonly include outpatient clinics, home health visits, long-term care facilities, and DME supplier locations.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
NU | New equipment | Use when the pouch is the first time item issued to the patient for this ostomy application. |