A5071 Ostomy Pouch HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS Level II A5071: Urinary Ostomy Pouch, One-Piece with Barrier Attached

HCPCS Level II code A5071 identifies a one-piece urinary ostomy pouch with an attached barrier, a common durable medical supply for patients with a urostomy. The code is important nationally because it standardizes billing for a frequently needed appliance that affects patient quality of life, home-care supply management, and durable medical equipment (DME) coverage decisions.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise description of what the code represents, the typical clinical contexts in which the item is used, and the sites of service where the supply is supplied or billed. The publication outlines benchmarking and coverage considerations for these payers, highlights clinical context for urinary diversion supplies, and flags where data are not available in the input.

This overview equips billing professionals, DME suppliers, and policy analysts with a clear, national-level reference for A5071, including the clinical purpose of the pouch, typical service settings, and the set of major payers covered in this analysis. Data not available in the input are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA5071HCPCS Level IIostomy pouchurostomydurable medical equipmenthome healthmedical suppliesostomy care

Billing Code Overview

HCPCS Level II code A5071 describes an ostomy pouch, urinary; with barrier attached (one-piece), each. This supply is used to collect urine externally following urinary diversion procedures and is intended for patients with a urostomy.

Service type: Durable medical supply / ostomy appliance

Typical site of service: Home health care, outpatient clinics, durable medical equipment suppliers, and inpatient hospital settings where ostomy supplies are provided for patient use

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a history of radical cystectomy for muscle-invasive bladder cancer presents for routine follow-up and ostomy supplies refills. The patient has a urinary conduit (ileal conduit) with a stoma requiring a one-piece ostomy pouch with an integrated skin barrier. The pouch is being replaced by a trained ostomy nurse during an outpatient clinic visit or supplied to the patient for home use. The workflow includes assessment of the stoma and peristomal skin, selection of an appropriately sized A5071 ostomy pouch (urinary; with barrier attached, one-piece), measurement of the stoma, cleansing the peristomal area, application of the pouch, patient education on emptying and changes, documentation of the appliance supplied, quantity dispensed, and any wound/skin findings. Typical site of service: outpatient clinic, home health visit, or durable medical equipment supplier. Service type: durable medical equipment/supplies (DMEPOS) – ostomy appliance supply (urinary ostomy pouch with attached barrier). Typical patient scenario includes patients with urinary diversion (ileal conduit or urostomy) after cystectomy, traumatic bladder loss, or congenital urinary tract anomalies requiring continuous urinary collection via a stoma.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier—standard billing	Use when no special circumstances apply to the supply billing.

HCPCS A4372: Ostomy Skin Barrier, Solid 4 x 4 with Convexity

HCPCS-A7505-TRACHEOSTOMA-HOUSING-HEAT-MOISTURE-EXCHANGE

HCPCS A7505: Reusable Tracheostoma Housing for Heat and Moisture Exchange

HCPCS-A7000-DISPOSABLE-SUCTION-CANISTER

HCPCS A7000: Disposable Canister for Suction Pump, Each

HCPCS-A4306-DISPOSABLE-LOW-FLOW-DRUG-DELIVERY-SYSTEM

HCPCS Level II A4306: Disposable Drug Delivery System, <50 ml/hr

HCPCS-A4649-SURGICAL-SUPPLY-MISCELLANEOUS

HCPCS Level II A4649: Surgical Supply, Miscellaneous

HCPCS-A4612-BATTERY-CABLES-REPLACEMENT-PATIENT-VENTILATOR

HCPCS Level II A4612: Battery Cables Replacement for Patient Ventilator

HCPCS-A7018-DISTILLED-WATER-LARGE-VOLUME-NEBULIZER-1000ML

HCPCS A7018: Distilled Water for Large-Volume Nebulizer, 1000 ml

HCPCS-A7038-DISPOSABLE-FILTER-POSITIVE-AIRWAY-PRESSURE-DEVICE

HCPCS A7038: Disposable Filter for Positive Airway Pressure Device

HCPCS-A6610-GRADIENT-COMPRESSION-STOCKING-BELOW-KNEE-18-30-MMHG-CUSTOM

HCPCS Level II A6610: Below-Knee Custom Gradient Compression Stocking

HCPCS-A4261-CERVICAL-CAP-CONTRACEPTIVE-DEVICE

HCPCS A4261: Cervical Cap for Contraceptive Use

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Taxonomy Code	Specialty	Notes
325200000X	Wound Care/Wound Management	Clinicians specializing in ostomy/wound care who evaluate stomas and fit appliances.
207Q00000X	Urology	Urologists who perform cystectomy/urostomy creation and coordinate postoperative ostomy care.
251E00000X	Enterostomal Therapist (WOC Nurse)	Wound Ostomy Continence (WOC) nurses who perform appliance fitting, education, and supply ordering.
261QM0800X	Home Health Care Provider	Home health clinicians who provide supplies and perform ostomy maintenance in the home setting.
332B00000X	Durable Medical Equipment Supplier	DMEPOS suppliers who dispense `A5071` ostomy pouches and manage billing for supplies.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N32.0`	Bladder neck obstruction	May lead to urinary diversion or ongoing stoma management in complex lower urinary tract disease.
`N32.9`	Disorder of bladder, unspecified	General bladder disorders that can culminate in urinary diversion and need for a urinary ostomy pouch.
`C67.9`	Malignant neoplasm of bladder, unspecified	Bladder cancer often treated with radical cystectomy and urinary diversion necessitating a urostomy and `A5071` pouches.
`Z93.0`	Urostomy status	Designates the presence of a urinary stoma and directly supports medical necessity for ostomy appliances like `A5071`.
`S37.3`	Injury of bladder	Traumatic bladder injury requiring diversion or long-term catheterization and ostomy care.
`Q64.8`	Other congenital malformations of urinary system	Congenital anomalies necessitating urinary diversion and long-term ostomy appliance use.
`L89.90`	Pressure ulcer of unspecified site, stage unspecified	Peristomal skin breakdown and pressure-related wounds impact appliance fit and may require specialized pouching.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44204`	Enterostomal stoma revision, including closure of fistula (limited)	May precede or follow supply needs if stoma revision is required; surgical management that changes appliance selection.
`97597`	Debridement, open wound, partial-thickness (e.g., debridement of peristomal skin breakdown), first 20 sq cm or less	Used when peristomal skin requires debridement prior to or during ostomy appliance management; supports clinical care documented with supply dispensing.
`99070`	Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit	Billed when specific ostomy supplies are furnished in the office in addition to routine visit components (payer-dependent).
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, 3-10 minutes	Ancillary counseling code that may be provided during an ostomy clinic visit for relevant behavioral counseling (example of concurrent services).
`G0463`	Hospital outpatient clinic visit for assessment and management of a patient	Used in hospital outpatient settings where ostomy appliance supply and fitting occur as part of clinic services (facility perspective).
`A9270`	Non-covered item or service (miscellaneous DME supply)	Occasionally used by suppliers when an exact HCPCS DME code is not available; not typically appropriate when `A5071` applies.

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