Summary & Overview
HCPCS A4417: Closed Ostomy Pouch with Convexity and Filter
HCPCS Level II code A4417 represents a one-piece, closed ostomy pouch with an attached barrier, built-in convexity, and an integrated filter. This supply is used in ostomy management to contain effluent, accommodate stoma morphology with convexity, and reduce gas-related issues via the filter. Nationally, ostomy supplies such as this affect home health, durable medical equipment, and outpatient wound-care services, and are important for patient quality of life and ongoing supply coverage.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, plus a synthesis of payer coverage considerations and common modifiers used with durable medical supplies. The publication outlines benchmarks for coding and billing practice, summarizes common coverage patterns across major payers, and highlights policy or documentation elements that influence coverage decisions. Clinical context addresses indications for closed ostomy pouches with convexity and filter use, while billing context covers typical supply-line reporting and service settings. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code A4417 describes an ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each. This item is a single-piece, closed ostomy pouch that includes an integrated adhesive barrier and built-in convexity to assist fit and stoma protrusion management, and a filter to help manage gas.
-
Service type: Durable medical supply for ostomy management; pouching system component
-
Typical site of service: Durable medical equipment supply, home use, outpatient clinics, wound and ostomy care settings
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a permanent end stoma following colorectal surgery (for example, abdominoperineal resection or permanent colostomy) who requires a closed ostomy pouch with an integrated skin barrier and built-in convexity to manage a flush or retracted stoma and to help maintain a seal. The pouch includes a filter to release gas and reduce ballooning. Clinical workflow: wound/ostomy nurse or enterostomal therapist assesses the stoma and peristomal skin, documents stoma type, size, and issues (retraction, peristomal creasing, or leakage). The clinician selects a one-piece, closed ostomy pouch with barrier and convexity such as A4417 sized to the stoma, educates the patient or caregiver on application and disposal, provides written supplies instructions, and documents medical necessity (e.g., persistent leakage, peristomal skin breakdown, or inability to use flat wafer due to body contour). The product is dispensed in the outpatient clinic or durable medical equipment channel and billed using HCPCS code A4417 with applicable modifiers for payer, service circumstance, or provider role.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Typically not used for HCPCS; reserved when no other modifier applies |