This section covers a wide variety of medical and surgical supplies, as well as some DME-related supplies and accessories. Medicare generally covers DME-related supplies, accessories, maintenance, and repair under the prosthetic devices provision.

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• A4369

  Ostomy skin barrier, liquid (spray, brush, etc.), per oz

• A4371

  Ostomy skin barrier, powder, per oz

• A4372

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

• A4373

  Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each

• A4375

  Ostomy pouch, drainable, with faceplate attached, plastic, each

• A4376

  Ostomy pouch, drainable, with faceplate attached, rubber, each

• A4377

  Ostomy pouch, drainable, for use on faceplate, plastic, each

• A4378

  Ostomy pouch, drainable, for use on faceplate, rubber, each

• A4379

  Ostomy pouch, urinary, with faceplate attached, plastic, each

• A4380

  Ostomy pouch, urinary, with faceplate attached, rubber, each

• A4381

  Ostomy pouch, urinary, for use on faceplate, plastic, each

• A4382

  Ostomy pouch, urinary, for use on faceplate, heavy plastic, each

• A4383

  Ostomy pouch, urinary, for use on faceplate, rubber, each

• A4384

  Ostomy faceplate equivalent, silicone ring, each

• A4385

  Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each

• A4387

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

• A4388

  Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each

• A4389

  Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each

• A4390

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

• A4391

  Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each

• A4392

  Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each

• A4393

  Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each

• A4394

  Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce

• A4395

  Ostomy deodorant for use in ostomy pouch, solid, per tablet

• A4396

  Ostomy belt with peristomal hernia support

• A4397

  Irrigation supply; sleeve, each

• A4398

  Ostomy irrigation supply; bag, each

• A4399

  Ostomy irrigation supply; cone/catheter, with or without brush

• A4400

  Ostomy irrigation set

• A4402

  Lubricant, per ounce

• A4404

  Ostomy ring, each

• A4405

  Ostomy skin barrier, non-pectin based, paste, per ounce

• A4406

  Ostomy skin barrier, pectin-based, paste, per ounce

• A4407

  Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each

• A4408

  Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each

• 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

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HCPCS Level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association). — Updated 7/24/2026

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