HCPCS Range Ostomy Pouches and Supplies

• 1 Ostomy pouch, closed; with barrier attached (1-piece), each ( A5051 )

• 2 Ostomy pouch, closed; without barrier attached (1-piece), each ( A5052 )

• 3 Ostomy pouch, closed; for use on faceplate, each ( A5053 )

• 4 Ostomy pouch, closed; for use on barrier with flange (2-piece), each ( A5054 )

• 5 Stoma cap ( A5055 )

• 6 Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1-piece), each ( A5056 )

• 7 Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1-piece), each ( A5057 )

• 8 Ostomy pouch, drainable; with barrier attached, (1-piece), each ( A5061 )

• 9 Ostomy pouch, drainable; without barrier attached (1-piece), each ( A5062 )

• 10 Ostomy pouch, drainable; for use on barrier with flange (2-piece system), each ( A5063 )

• 11 Ostomy pouch, urinary; with barrier attached (1-piece), each ( A5071 )

• 12 Ostomy pouch, urinary; without barrier attached (1-piece), each ( A5072 )

• 13 Ostomy pouch, urinary; for use on barrier with flange (2-piece), each ( A5073 )

• 14 Stoma plug or seal, any type ( A5081 )

• 15 Continent device; catheter for continent stoma ( A5082 )

• 16 Continent device, stoma absorptive cover for continent stoma ( A5083 )

• 17 Ostomy accessory; convex insert ( A5093 )