Summary & Overview
HCPCS A5062: Ostomy Pouch, Drainable, One-Piece
HCPCS Level II code A5062 designates a drainable ostomy pouch without an attached barrier (one-piece), a common durable medical supply used for stoma output collection. This code matters nationally because ostomy supplies are routinely prescribed for patients with ostomies after colorectal, urologic or other abdominal surgeries and for long-term bowel or urinary diversion management. Proper coding affects supply coverage, patient access, and claims processing across public and commercial payers.
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 a drainable ostomy pouch, typical sites of service (outpatient medical supply and home settings), and what to expect from payer coverage frameworks. The publication highlights benchmark considerations for reimbursement and utilization, summarizes relevant policy updates where available, and clarifies documentation elements that commonly accompany supply claims.
This resource is aimed at billing staff, clinicians coordinating ostomy care, and policy analysts seeking a national perspective on coding and supply classification for ostomy management. Data not available in the input for payor-specific rates, associated taxonomies, and ICD-10 linkage are noted where applicable.
Billing Code Overview
HCPCS Level II code A5062 describes an ostomy pouch, drainable; without barrier attached (one-piece), each. The service type is ostomy appliance supply, intended for patients requiring a drainable pouch for stoma output management. The typical site of service is outpatient or home medical supply settings, including durable medical equipment suppliers and outpatient clinics that coordinate ostomy care.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a surgically created stoma (ileostomy or colostomy) requiring a replaceable, drainable ostomy pouch without an attached skin barrier. The device A5062 is supplied in outpatient clinics, wound-ostomy-continence (WOC) nurse visits, home health visits, or durable medical equipment (DME) suppliers. A common scenario: a patient discharged after colorectal resection with a loop ileostomy returns for outpatient stoma care education and receives A5062 pouches for ongoing drainage management. The clinical workflow includes stoma assessment by a WOC nurse, measurement of stoma and peristomal skin, selection of the appropriate pouch ring size, patient education on emptying and cleaning the drainable pouch, documentation of quantity and medical necessity, and billing the item to the patient’s insurer. Typical settings: outpatient wound clinic, home health, long-term care facility, or outpatient DME pick-up. The pouch is used for ongoing management of fecal output, protection of peristomal skin, and facilitation of stoma care between surgical stoma reversal or as permanent therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
NU | New equipment | Use when the pouch is first-time issue as new durable medical equipment to the patient. |