Summary & Overview
HCPCS A4427: Ostomy Pouch, Drainable with Locking Flange and Filter
HCPCS Level II code A4427 represents a drainable ostomy pouch designed for use with a barrier that has a locking flange and includes a filter as part of a two-piece system. Nationally, ostomy supplies like this are essential for maintaining skin integrity, managing effluent, and supporting patients living with stomas. Coverage and utilization of this supply affect patient quality of life and program costs across commercial payers and Medicare.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for use of the device, typical sites of service (including home health and outpatient/DME settings), and the common billing environment for ostomy supply items. The publication summarizes available benchmarks and payer coverage considerations where provided, highlights areas where policy updates can affect access, and outlines the relevant coding context for clinicians, billing professionals, and policy analysts.
This summary is written for a national audience and focuses on the code definition, clinical role of the product, and the payer landscape. Data not available in the input is noted as such in relevant sections of the full publication.
Billing Code Overview
HCPCS Level II code A4427 describes an ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each. This item is a durable medical supply intended for patients with a stoma who require a drainable collection pouch that attaches to a compatible barrier with a locking flange. The service type is supply of an ostomy pouching system component, and the typical site of service is outpatient care settings, home health care, durable medical equipment providers, and other non-facility settings where ostomy supplies are used by patients or caregivers.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a surgically created stoma (ileostomy or colostomy) who requires a two‑piece, drainable ostomy pouch with a locking flange and integrated filter for routine wear and pouch changes. The patient presents to an outpatient wound, ostomy, and continence (WOC) clinic or durable medical equipment (DME) supplier for a supply refill and device fitting. The clinical workflow includes verification of the stoma type and peristomal skin status, measurement of stoma diameter, assessment of pouching system compatibility with the existing barrier/skin barrier with locking flange, education on pouch emptying and filter function, and documentation of medical necessity (e.g., chronic ostomy following colorectal surgery, tumor resection, or inflammatory bowel disease). The supplier or WOC nurse ensures the pouch A4427 (ostomy pouch, drainable; for use on barrier with locking flange, with filter, two‑piece system) matches the barrier flange size and locking mechanism, obtains any required prior authorization from payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, or Medicare, and dispenses the item with appropriate frequency and ICD‑10 linkage for billing and durable medical equipment records.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no specific modifier applies |