Summary & Overview
HCPCS A4432: Urinary Ostomy Pouch for Non-Locking Flange
HCPCS Level II code A4432 identifies a two-piece urinary ostomy pouch designed for use on a barrier with a non-locking flange and a faucet-type tap with valve. This durable medical supply code matters nationally as it defines billable ostomy pouch products used in post-operative urinary diversion care and long-term management of urostomies. Clear coding supports appropriate coverage decisions, supplier reimbursement, and continuity of patient access to necessary supplies.
Key payers commonly involved in coverage for ostomy supplies include Medicare, Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find an overview of what A4432 represents, payer coverage context, and the clinical and service settings where this supply is used. The publication outlines typical billing considerations, common modifiers relevant to supply billing, and where this item fits in ostomy care workflows. It also summarizes available benchmarks and policy updates where applicable and indicates when input data was not provided. The goal is to give clinicians, billing staff, and policy analysts a concise reference for coding and coverage conversations around urinary ostomy pouch supplies.
Billing Code Overview
HCPCS Level II code A4432 describes an ostomy pouch, urinary, designed for use on a barrier with a non-locking flange, and featuring a faucet-type tap with valve (two-piece). The code represents a disposable medical supply used to collect urine following urinary diversion procedures.
Service type: Durable medical supply / ostomy supply
Typical site of service: Home use, outpatient clinics, and long-term care settings where ostomy supplies are provided to patients for self-care or caregiver administration
Clinical & Coding Specifications
Clinical Context
A patient with a urinary diversion using a two-piece ostomy system presents to an outpatient durable medical equipment (DME) supplier to obtain a replacement urinary ostomy pouch. The pouch A4432 is a urinary ostomy pouch designed for use on a skin barrier with a non-locking flange and includes a faucet-type tap with valve (two-piece system). Typical patients include those with ileal conduits or other incontinent urinary diversions following radical cystectomy for bladder cancer, complex pelvic trauma with urinary diversion, or neurogenic bladder requiring permanent conduit. The clinical workflow begins with the treating urologist or ostomy nurse documenting the need for a replacement pouch, specifying the two-piece non-locking flange system with faucet-type tap, and providing an order to the DME supplier. The supplier verifies insurance eligibility, selects the proper pouch size and features, bills using A4432, and dispenses the item with teaching on pouch attachment, valve operation, and routine maintenance. Follow-up typically occurs with the ostomy nurse or urology clinic to assess fit, skin integrity, and function of the faucet-type valve.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use if additional work or complexity is documented by the supplier or clinician beyond typical dispensing or fitting. |