Summary & Overview

HCPCS Level II A5073: Urinary Ostomy Pouch, Two-Piece

HCPCS Level II code A5073 identifies a urinary ostomy pouch intended for use with a separate barrier that has a flange in a two-piece system. This supply-level code matters nationally because ostomy supplies are essential for ongoing urinary diversion management, drive durable medical equipment (DME) coverage decisions, and represent a recurring cost element for patients and payers.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and the types of coverage considerations that surround ostomy pouch supplies. The publication summarizes benchmark topics relevant to supply utilization and reimbursement, highlights common billing and documentation considerations, and notes where policy updates or program guidance typically affect coverage decisions for ostomy supplies.

The piece is aimed at billing professionals, clinical supply coordinators, and policy analysts seeking a national-level briefing on A5073 — what it covers, where it is used, and what payers and programs commonly consider when processing claims. Data not available in the input is flagged explicitly elsewhere.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA5073HCPCS Level IIostomy supplyurinary diversiondurable medical equipmenthome health suppliesmedical billingsupply coding

Billing Code Overview

HCPCS Level II code A5073 describes an ostomy pouch for urinary use designed to attach to a barrier with a flange in a two-piece system. The item is billed per each pouch.

Service type: Durable medical supply for ostomy management

Typical site of service: Home or outpatient setting where accessory ostomy supplies are used, including home care, outpatient clinics, and long-term care facilities.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a surgically created urinary stoma (urostomy) following cystectomy, bladder diversion (ileal conduit), or severe lower urinary tract injury. The patient presents for outpatient durable medical equipment supply replacement and requires a two‑piece urinary ostomy pouch designed to attach to a flange barrier. The clinical workflow includes verification of the physician order, confirmation of stoma type and appliance compatibility, measurement of stoma size, selection of a compatible flange and pouch, patient education on application and wear time, documentation of medical necessity (diagnosis supporting need for urostomy appliance), and billing of the ostomy pouch supply using A5073 per unit. Typical encounters occur in outpatient wound/ostomy clinics, home health visits, urology clinics, or durable medical equipment supplier visits. Coordination with the patient’s insurer (for example, Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, BUCA, or Medicare) for prior authorization or coverage verification commonly occurs prior to dispensing larger quantities.

Coding Specifications

Modifier	Description	When to Use
`00`	Default/No modifier	Use when no other modifier applies to the supply claim.
`11`	Professional component	Not typically used for DME supplies; include only if a professional component was billed separately by a clinician for related service.
`22`	Increased procedural services	Rare for supplies; use when additional work beyond typical supply dispensation is documented and allowed by payer rules.
`52`	Reduced services	Use if a partial supply or reduced service is provided compared to the billed quantity.
`53`	Discontinued procedure	Use if order was canceled after initiation but before completion of supply dispensation.
`59`	Data not available in the input.	Data not available in the input.
`62`	Two surgeons	Not typically applicable to ostomy pouch supply; used when two surgeons share operative responsibility.
`78`	Unplanned return to OR by same physician following initial procedure	Not applicable to supply billing; included only if related to documented surgical events.
`80`	Assistant at surgery	Not applicable for supply billing; use only in operative contexts.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	Use when an advanced practice clinician provided the service and payer requires this modifier for identification.
`KX`	Requirements specified in the medical policy are met	Use to indicate that documentation meets payer-specific medical necessity criteria for supplies.
`NU`	New equipment	Use when the ostomy appliance is initial provision of a new device to the beneficiary.
`RR`	Registered nurse	Use when a registered nurse provides a billable professional component or education visit recognized by the payer.
`UE`	Left upper extremity (anatomic modifier)	Not applicable to ostomy supplies; included only if required by system mapping but generally not used here.

Taxonomy Code	Specialty	Notes
`173E00000X`	General Surgery	Surgeons who perform cystectomy and create urinary diversions.
`2080P0207X`	Urology	Urologists who manage urostomy creation and follow‑up care.
`334500000X`	Wound Care	Wound/Ostomy care clinicians who manage pouching systems and patient education.
`367A00000X`	Home Health	Home health clinicians who provide ostomy supplies and education in the home setting.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z43.2`	Ostomy status	Indicates presence of urostomy and medical necessity for ostomy supplies.
`Z94.0`	Kidney transplant status	Patients with urinary diversions or altered urinary anatomy may require specialized supplies.
`N13.7`	Hydronephrosis with ureteral stricture	Underlying urologic conditions that may lead to diversion and need for urostomy care.
`C67.9`	Malignant neoplasm of bladder, unspecified	Bladder cancer often treated with cystectomy and urostomy creation, necessitating ongoing supplies.
`S37.89`	Injury of other specified intra‑abdominal organs	Traumatic injury leading to urinary diversion and need for ostomy pouching systems.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`A4270`	Adjustment to an external prosthetic device (office visit)	Often used when a clinician adjusts or refits the ostomy pouching system in clinic; relevant to sizing and appliance selection.
`90960`	Dialysis procedure other than hemodialysis; peritoneal dialysis training and subsequent training	Not directly related; Data not available in the input.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Commonly billed for a clinic visit where ostomy supplies are ordered or ostomy care is reviewed.
`G0463`	Hospital outpatient clinic visit for assessment and management	Used when ostomy evaluation and supply coordination occur in a hospital outpatient clinic.
`A4249`	Ostomy pouch/skin barrier, not otherwise specified	May be billed for alternative ostomy pouch supplies when `A5073` is not appropriate; relevant for supply comparisons.