HCPCS Codes for Lump sum purchase of DME, prosthetics, orthotics


  • A4409

    Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each
  • A4410

    Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each
  • A4411

    Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each
  • A4412

    Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each
  • A4413

    Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each
  • A4414

    Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each
  • A4415

    Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each
  • A4416

    Ostomy pouch, closed, with barrier attached, with filter (1 piece), each
  • A4417

    Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each
  • A4418

    Ostomy pouch, closed; without barrier attached, with filter (1 piece), each
  • A4419

    Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each
  • A4420

    Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each
  • A4421

    Ostomy supply; miscellaneous
  • A4422

    Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each
  • A4423

    Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each
  • A4424

    Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each
  • A4425

    Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each
  • A4426

    Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each
  • A4427

    Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each
  • A4428

    Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each
  • A4429

    Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each
  • A4430

    Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each
  • A4431

    Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each
  • A4432

    Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each
  • A4433

    Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each
  • A4434

    Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each
  • A4435

    Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each
  • A4436

    Irrigation supply; sleeve, reusable, per month
  • A4437

    Irrigation supply; sleeve, disposable, per month
  • A4438

    Adhesive clip applied to the skin to secure external electrical nerve stimulator controller, each
  • A4455

    Adhesive remover or solvent (for tape, cement or other adhesive), per ounce
  • A4456

    Adhesive remover, wipes, any type, each
  • A4470

    Gravlee jet washer
  • A4480

    Vabra aspirator
  • A4481

    Tracheostoma filter, any type, any size, each
  • A4483

    Moisture exchanger, disposable, for use with invasive mechanical ventilation
  • A4490

    Surgical stockings above knee length, each
  • A4495

    Surgical stockings thigh length, each
  • A4500

    Surgical stockings below knee length, each
  • A4510

    Surgical stockings full length, each
  • A4541

    Monthly supplies for use of device coded at e0733
  • A4542

    Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist
  • A4555

    Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only
  • A4556

    Electrodes, (e.g., apnea monitor), per pair
  • A4557

    Lead wires, (e.g., apnea monitor), per pair
  • A4558

    Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per oz
  • A4559

    Coupling gel or paste, for use with ultrasound device, per oz
  • A4561

    Pessary, reusable, rubber, any type
  • A4562

    Pessary, reusable, non rubber, any type
  • A4563

    Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each