Summary & Overview
HCPCS A4428: Urinary Ostomy Pouch with Extended-Wear Barrier and Tap Valve
HCPCS Level II code A4428 denotes a one-piece urinary ostomy pouch with an integrated extended-wear barrier and a faucet-type drainage valve. This durable medical equipment code is relevant nationally for clinicians, suppliers, and payers because it identifies a specific ostomy supply used for urinary diversion that can affect patient comfort, device longevity, and billing pathways for home and outpatient care. Coverage and payment policies for ostomy supplies influence access to these products for patients with urinary diversions.
Key payers in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of what A4428 covers clinically, typical sites of service, common billing modifiers, and where to look for payer-specific coverage criteria. The publication outlines benchmarks and policy guidance relevant to durable medical equipment billing, highlights clinical use considerations for urinary ostomy pouches with extended-wear barriers and faucet taps, and explains documentation and coding context that affects reimbursement and supplier workflows.
Where detailed payer coverage, taxonomies, ICD-10 pairings, or related codes are required, the report notes availability or absence of those fields. The content is intended for national audiences involved in revenue cycle, clinical supply decisions, and policy compliance for ostomy supply billing.
Billing Code Overview
HCPCS Level II code A4428 represents an ostomy pouch for urinary diversion that is a one-piece device with an extended wear barrier attached and a faucet-type tap with valve. The description indicates the item is a urinary ostomy pouch designed for users requiring a secure, long-wear adhesive barrier integrated with the pouch and a built-in faucet-style drainage valve.
Service Type: Durable Medical Equipment / Ostomy Supplies
Typical Site of Service: Home use or outpatient settings where ostomy supplies are provided, including home health supply delivery and outpatient durable medical equipment vendors.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a urinary diversion following cystectomy (for bladder cancer, neurogenic bladder, or severe trauma) who uses a one‑piece urinary ostomy pouch with an extended wear barrier and faucet‑type tap for drainage. The device is supplied in outpatient or home health settings for routine pouch replacement and urinary collection. Clinical workflow: a wound/ostomy nurse or home health clinician assesses stoma and peristomal skin, selects appropriate pouch size and barrier, documents stoma measurements and skin condition, trains the patient or caregiver on emptying the faucet‑type tap, schedules routine resupply, and records device HCPCS A4428 on the durable medical equipment claim. Typical site of service: outpatient wound/ostomy clinic, home health, long‑term care facility, or outpatient supply dispensing location. Typical patient scenario: a patient post‑radical cystectomy with an ileal conduit requiring monthly supply of a one‑piece urinary ostomy pouch with extended wear barrier and an integrated faucet‑type tap for ease of drainage and caregiver use. Documentation includes diagnosis supporting medical necessity, stoma assessment, pouch size/type, frequency of replacement, and supplier details for billing A4428.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier |