Summary & Overview
HCPCS Level II A4426: Ostomy Pouch, Drainable, Two-Piece Locking Flange
HCPCS Level II code A4426 represents a drainable ostomy pouch designed for use with a barrier that has a locking flange in a two-piece ostomy system. This code covers a commonly used disposable or reusable pouch component that enables stool or effluent collection for patients with an intestinal stoma. Nationally, supplies like these are essential to post-operative care and ongoing management of ostomies, with implications for patient quality of life, supply procurement, and payer coverage policies.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare, reflecting major commercial and public coverage environments. Readers will find an overview of the clinical context for this supply, typical sites of service (outpatient clinics, home use), and the types of benchmarks and policy considerations relevant to coverage and billing for ostomy supplies. The report also outlines common billing modifiers and flags where data is not available in the input. This summary equips clinical administrators, billing professionals, and policy analysts with the core facts about A4426, what it covers, and where to look next for payer-specific limits and documentation requirements.
Billing Code Overview
HCPCS Level II code A4426 describes an ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each. The service type is durable medical supply: ostomy appliance. The typical site of service is outpatient or home use for patients with an ostomy, where the pouch is applied to a compatible skin barrier with a locking flange as part of a two-piece ostomy system.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a permanent end colostomy following low anterior resection for rectal cancer presents for routine stoma supply replenishment. The patient uses a two‑piece ostomy system with a separate skin barrier that has a locking flange; the clinician or home health nurse supplies a A4426 drainable ostomy pouch intended for use with that barrier. Typical workflow: the clinician confirms pouch size and flange compatibility, documents stoma condition and any peristomal skin issues, educates the patient or caregiver on pouch application and emptying technique, and dispenses or orders the correct quantity of A4426 pouches. Typical site of service is home health, outpatient wound/ostomy clinic, durable medical equipment supplier, or a hospital outpatient pharmacy when supplies are issued on discharge. Service type: durable medical equipment (DME)/supply for ostomy care used in ambulatory, home, or post‑acute care settings.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier applicable | Not commonly appended; reserved when no other modifier applies. |
11 |