Summary & Overview
HCPCS A4413: Ostomy Pouch, Drainable, High Output
HCPCS Level II code A4413 denotes a drainable, high-output ostomy pouch for use with a two-piece barrier and flange, supplied with a filter. Ostomy supplies are essential durable medical equipment that support long-term management of bowel or urinary stomas. Nationally, appropriate coding for ostomy appliances affects patient access to needed supplies, supply-chain reimbursement, and care continuity for patients managed in home health, outpatient, and long-term care settings. Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. This publication provides a concise overview of the code's clinical role, typical sites of service, and payer coverage context. Readers will find benchmarks for coverage and reimbursement patterns, common billing modifiers and coding considerations, and the clinical context that distinguishes high-output, drainable pouches from other ostomy appliance types. Where available, the report highlights policy updates and payer-specific documentation expectations that commonly influence claim adjudication. Data not available in the input for specific rate benchmarks and associated ICD-10 diagnoses are noted where relevant.
Billing Code Overview
HCPCS Level II code A4413 describes an ostomy pouch, drainable, high output, designed for use with a two-piece barrier system with flange and including a filter, furnished as each unit. This supply is intended for patients with stomas that produce higher-volume effluent and who require a drainable pouching option compatible with a two-piece ostomy barrier.
Service type: Durable medical supply / ostomy appliance
Typical site of service: Home health, outpatient clinics, long-term care facilities, and skilled nursing facilities
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a long-standing end colostomy following colorectal cancer surgery requires a drainable, high-output ostomy pouch designed for use with a two-piece barrier and flange system that incorporates a filter. The patient presents to an outpatient ostomy clinic where a wound, ostomy, and continence (WOC) nurse evaluates pouch fit, peristomal skin integrity, and output characteristics. The workflow includes assessment of stoma size and shape, measurement for the appropriate flange and barrier, selection of a high-output drainable pouch with integrated filter to manage frequent effluent and odor control, patient education on pouch changes and drain care, and documentation of medical necessity for a larger-capacity drainable system.
Typical site of service is an outpatient clinic or home health visit where ostomy supplies are supplied to the patient. Supply dispensing may also occur in a durable medical equipment (DME) provider setting when prescribed by the treating clinician.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier applicable | Rarely used; indicates no modifier is reported when required by payer rules. |
11 |