Summary & Overview
HCPCS Level II A4419: Closed Ostomy Pouch with Filter
HCPCS Level II code A4419 denotes a closed ostomy pouch designed for use with a non-locking flange barrier and fitted with a filter as part of a two-piece ostomy system. This supply is commonly used by patients with colostomies or ileostomies for outpatient and home-based stoma management. Nationally, ostomy supplies represent a routine but essential category of durable medical equipment that affects patient quality of life and ongoing care costs.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage patterns, coding and billing considerations, and clinical context for using a closed, filtered ostomy pouch in two-piece systems. Readers will find benchmarks for utilization and reimbursement where available, summaries of relevant policy updates, and practical clinical context on device function and sites of service.
Intended takeaways include: how HCPCS Level II code A4419 is used to bill for two-piece closed ostomy pouches with filters; which payer types typically cover such supplies; typical settings where the item is supplied (outpatient clinics, home health, and community care); and where to look for policy language or updates. Data not available in the input will be clearly noted in the detailed sections.
Billing Code Overview
HCPCS Level II code A4419 describes an ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each. This item is a disposable closed ostomy pouch intended to collect stoma output and is designed to attach to a non-locking flange barrier as part of a two-piece ostomy system.
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Service type: Ostomy supplies and accessories
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Typical site of service: Durable medical equipment supplied in outpatient settings, home health, or community-based care for patients with a stoma
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a long-standing history of colorectal cancer underwent a permanent end colostomy following low anterior resection complicated by anastomotic leak. The patient presents to an outpatient ostomy clinic for routine supplies and appliance management. The ostomy nurse assesses the stoma and peristomal skin, confirms the existing two-piece ostomy system with a non-locking flange and an integrated filter, and determines the patient requires replacement closed ostomy pouches due to normal wear and routine resupply. The workflow includes verification of the prescription, documentation of stoma size and peristomal skin condition, selection of a closed, two-piece pouch with filter (compatible with the patient’s barrier/skin barrier flange), preparation of face-to-face or chart-based order, dispensing the pouching supplies, and providing brief education on pouch change and filter function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (standard billing) | Use when no specific modifier applies to the supply claim. |
11 | Primary procedure or service | Use when this ostomy pouch supply is the primary billed item on the claim. |