Summary & Overview
HCPCS A4387: Closed One-Piece Ostomy Pouch with Built-In Convexity
HCPCS Level II code A4387 represents a one-piece, closed ostomy pouch with an attached barrier and built-in convexity. Ostomy supplies are essential for outpatient and home-based stoma care and have nationwide clinical and cost implications because they are ongoing, consumable medical supplies required by patients after bowel diversion procedures. Coverage, coding, and costing of ostomy appliances affect patient access, provider billing, and durable medical equipment/supplies (DMEPOS) program management.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise national view of what A4387 denotes, how it is used clinically, and where it is typically provided.
Readers will learn practical benchmarks and context for billing and coverage: the clinical role of closed, convex ostomy pouches in managing stoma protrusion and peristomal seal; common sites of service such as outpatient clinics, home health, and long-term care; and the types of documentation and supply descriptors typically relevant to coverage decisions. Where specific payer or coding benchmarks are not available in the input, the report notes that data is not available in the input. The focus is national in scope and intended to inform coding staff, billing managers, and policy analysts about the clinical and billing identity of A4387.
Billing Code Overview
HCPCS Level II code A4387 describes an ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), each. This supply is a one-piece, closed ostomy pouch with an integrated skin barrier and built-in convexity intended to support stoma protrusion and improve seal against the abdomen.
Service type: Durable medical supply — ostomy appliance
Typical site of service: Outpatient clinics, home health, long-term care facilities, and retail or specialty medical supply settings
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient with a surgically created stoma for fecal diversion presents for routine ostomy appliance supply. The clinician evaluates stoma contour, peristomal skin integrity, and output characteristics. For a patient with a retracted or flush stoma and peristomal creases, a one-piece closed ostomy pouch with an integrated barrier and built-in convexity is selected to improve seal and reduce leakage. Typical workflow: ostomy nurse performs assessment, documents stoma measurements and skin findings, selects appropriate flange size and convexity level, fits a sample appliance, provides patient education on wear-time and disposal, and records the item dispensed. This supply is dispensed for single-use closed collection when the patient does not require drainage or irrigation (commonly used for colostomy with formed stool). Typical site of service is outpatient clinics, home health visits, durable medical equipment supplier locations, and inpatient hospital discharge planning where supplies are provided prior to discharge.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
NU | New equipment | Use when the ostomy pouch is furnished as new equipment to the patient for initial issue. |
RR | Rental (not typically used for consumables) |