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    v1.0.28
    OpenPayerBilling CodesMedical And Surgical SuppliesHCPCS hcpcs-a5063-ostomy-pouch-drainable-2-piece-flange
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    HCPCS Level II A5063: Drainable Ostomy Pouch for Flanged Barrier

    HCPCS Level II code A5063 describes a drainable ostomy pouch designed for use on a barrier with a flange (two‑piece system), each; this is a durable medical supply used for ostomy management, typically supplied as a disposable pouch component to be attached to a skin barrier with a flange, and commonly provided in outpatient settings such as home health supply delivery, durable medical equipment suppliers, and ambulatory clinics that manage ostomy care.

    For related coverage guidance, see recent payer policy updates: Salivary Hormone Testing, Bone Turnover Markers Testing, Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing.

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old patient with a permanent end colostomy presents to a durable medical equipment supplier for routine ostomy supply replenishment. The patient uses a two-piece ostomy system consisting of a skin barrier with a flange and separate drainable pouch. A home health nurse or ostomy clinic clinician confirms the stoma is healthy, the peristomal skin is intact, and the current pouching system fits appropriately. The supplier documents the prescription, quantity, and medical necessity and dispenses a drainable ostomy pouch for use with a flange-type barrier. Typical workflow: clinician documents the need in the medical record and provides an order; durable medical equipment supplier verifies insurance coverage, selects the appropriate A5063 product, records the supplier NPI and taxonomy, and ships or provides the pouch to the patient for outpatient/home use. Typical site of service is outpatient durable medical equipment supply, home health delivery, or ambulatory clinic ostomy supply distribution.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    49440Creation of ileostomy or jejunostomy, or external stomaSurgical procedure that results in need for ostomy pouch supplies such as A5063
    44187Revision of ileostomy or colostomyPostoperative care and potential change in pouching system selection; supplies billed separately as A5063
    99502Home visit for postnatal care and management (used here as a home health visit analogy)Home health or nurse visit during which ostomy pouch fit and supply needs are assessed and A5063 may be dispensed
    94760Noninvasive ear or respiratory therapy (placeholder)Data not available in the input.
    45330Sigmoidoscopy, flexible; diagnosticDiagnostic procedures in colorectal evaluation that may precede surgical decisions for ostomy creation and subsequent supply needs

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    207P00000XEmergency Medicine PhysicianAn emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
    207UN0903XIn Vivo & In Vitro Nuclear Medicine PhysicianA nuclear medicine physician who specializes in in vivo and in vitro nuclear medicine.
    207RI0001XClinical & Laboratory Immunology (Internal Medicine) PhysicianAn internal medicine physician who specializes in clinical and laboratory immunology disease management.
    207RT0003XTransplant Hepatology PhysicianAn internist with special knowledge and the skill required of a gastroenterologist to care for patients prior to and following hepatic transplantation…
    207KI0005XClinical & Laboratory Immunology (Allergy & Immunology) PhysicianAn allergy and immunology physician who specializes in clinical and laboratory immunology disease management..
    2085U0001XDiagnostic Ultrasound PhysicianA Radiology doctor of Osteopathy that specializes in Diagnostic Ultrasound.
    237700000XHearing Instrument SpecialistIndividuals who test hearing for the selection, adaptation, fitting, adjusting, servicing, and sale of hearing aids. Hearing Instrument Specialist is …

    Related Payer Policy Updates

    Specialty: Endocrinology1 / 3

    5 rows

    PolicyPayerEffective Date
    Salivary Hormone TestingOscar Health2026-10-01
    Bone Turnover Markers TestingOscar Health2026-10-01
    Parathyroid Hormone, Phosphorus, Calcium, and Magnesium TestingOscar Health2026-10-01
    Testosterone — Coverage Criteria for Measurement and MonitoringOscar Health2026-10-01
    Thyroid Disease TestingOscar Health2026-10-01

    Related Codes

    HCPCS-A4206-STERILE-SYRINGE-1CC-NEEDLE

    HCPCS A4206: Syringe with Needle, 1 cc or Less, Sterile

    HCPCS-A4207-STERILE-2CC-SYRINGE-WITH-NEEDLE

    HCPCS Level II A4207: Syringe with Needle, Sterile 2 cc

    HCPCS-A4208-STERILE-3CC-SYRINGE-WITH-NEEDLE

    HCPCS Level II A4208: Syringe with Needle, Sterile 3 cc

    HCPCS-A4209-STERILE-SYRINGE-WITH-NEEDLE-5CC-OR-GREATER

    HCPCS Level II A4209: Syringe with Needle, Sterile 5 cc or Greater

    HCPCS-A4210-NEEDLE-FREE-INJECTION-DEVICE

    HCPCS Level II A4210: Needle-free Injection Device, Each

    HCPCS-A4211-SUPPLIES-SELF-ADMINISTERED-INJECTIONS

    HCPCS Level II A4211: Supplies for Self-Administered Injections

    HCPCS-A4212-NON-CORING-NEEDLE-STYLET-CATHETER-ACCESS-SUPPLY

    HCPCS Level II A4212: Non-coring Needle or Stylet with/without Catheter

    HCPCS-A4213-STERILE-SYRINGE-20CC-OR-GREATER

    HCPCS Level II A4213: Syringe, Sterile, 20 cc or Greater, Each

    HCPCS-A4215-STERILE-NEEDLE-SINGLE-EACH

    HCPCS Level II A4215: Needle, Sterile, Any Size

    HCPCS-A4216-STERILE-DILUENT-FLUSH-10ML

    HCPCS Level II A4216: Sterile Diluent/Flush, 10 ml

    Showing 1–10 of 633

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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