Summary & Overview
HCPCS Level II A4391: Urinary Ostomy Pouch, One-Piece with Extended-Wear Barrier
HCPCS Level II code A4391 identifies a one-piece urinary ostomy pouch with an attached extended-wear barrier. This durable medical supply is important for patients with urinary diversions who require reliable collection systems and skin protection. Nationally, supplies coded under A4391 affect access to outpatient and home-based ostomy care, durable medical equipment (DME) reimbursement, and patient out-of-pocket costs.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks for utilization and reimbursement patterns, an overview of payer coverage approaches, and clinical context for when a one-piece urinary ostomy pouch with an extended-wear barrier is used. The summary highlights common payment considerations, typical settings of supply use, and points of policy relevance for DME suppliers, clinicians managing urinary diversions, and billing professionals.
This publication provides a concise reference for the code’s clinical purpose, typical service location, payer landscape, and the types of benchmarking and policy information included. Data not available in the input will be identified where applicable.
Billing Code Overview
HCPCS Level II code A4391 describes an ostomy pouch, urinary, with extended wear barrier attached (one-piece), each. This item is a single-piece urinary ostomy pouch designed for collection and management of urinary output with an attached extended-wear skin barrier to support longer wear time.
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Service type: Durable medical supply for urinary ostomy management
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Typical site of service: Home use, outpatient clinics, long-term care facilities, and other non-acute settings where ostomy supplies are used by patients living with urinary diversions
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a permanent or temporary urinary stoma (urostomy) following cystectomy, urinary diversion (e.g., ileal conduit), spinal cord injury with neurogenic bladder, or refractory urinary incontinence treated with diversion. The patient presents to an outpatient durable medical equipment (DME) supplier, wound-ostomy clinic, home health nurse, or outpatient clinic for routine supply replacement. The service involves dispensing a single-piece urinary ostomy pouch with an integrated extended-wear skin barrier (A4391) to contain urine, protect peristomal skin, and provide longer wear time between changes. Workflow: clinician assesses the stoma and peristomal skin, confirms pouch type and size, documents indication and measurements, records the quantity dispensed and medical necessity, selects appropriate modifier(s) for billing, and provides patient education on application and wear-time. Typical site of service is outpatient clinic, wound-ostomy-continence nurse visit, home health visit, or DME supplier location. Typical supplies provided include the ostomy pouch, skin barrier, and patient instruction; adjustments or referrals occur if complications (leakage, dermatitis, peristomal excoriation) are identified.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no specific modifier applies and claim is otherwise standard |