Summary & Overview
HCPCS A5054: Closed Ostomy Pouch for Two-Piece System
HCPCS Level II code A5054 designates a closed ostomy pouch intended for use with a separate barrier that has a flange in a two-piece ostomy system. These pouches are single-use disposables used by patients with a stoma to collect output when a one-time-use pouch is preferred or clinically indicated. Nationally, ostomy supplies represent an ongoing component of durable medical equipment and outpatient supply coverage due to population aging and prevailing surgical practices.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code and its clinical context, typical sites of service (outpatient clinics, home health, and home use), and what to expect in payer coverage practices. The publication summarizes benchmarks where available, notes common billing modifiers provided in the input, and outlines policy and coverage considerations relevant to two-piece ostomy systems. This resource is intended to help billing professionals, supply chain managers, and clinicians understand coding and service implications for ostomy pouch procurement and claims submission at a national level. Data not available in the input is explicitly noted where applicable.
Billing Code Overview
HCPCS Level II code A5054 describes an ostomy pouch, closed; for use on barrier with flange (2 piece), each. This item is a single-use, closed ostomy pouch designed to attach to a separate skin barrier with a flange in a two-piece ostomy system. The service type is durable medical/surgical supply for ostomy management. The typical site of service is outpatient settings, home care, or other non-acute environments where ostomy supplies are provided to patients managing a stoma.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a permanent end colostomy from prior low anterior resection presents for routine outpatient ostomy appliance supply replacement. The clinician assesses stoma size, peristomal skin integrity, and selects a compatible two-piece barrier with a flange. A single-use, closed ostomy pouch is provided and documented in the medical record as a DME supply dispensed to the patient for home use. Typical workflow: stoma nurse evaluates patient, measures stoma, selects flange-compatible barrier system, dispenses A5054 pouch (one-piece of the two-piece system), documents product name/size, quantity, pouch lot number, reason for dispensing, and applies appropriate HCPCS modifier for billing. Typical site of service is outpatient clinic, home health supply dispensation, or durable medical equipment supplier pickup.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no other modifier is applicable for standard supply claim |
11 | Office or Other Outpatient | Use when item is furnished in an outpatient clinic visit setting |