2025 HCPCS code A4420
(Active) Effective Date: N/A Revision Date: N/A Medical Supplies - Ostomy Pouches and Supplies Medical and Surgical Supplies Feed
Closed ostomy pouch for use with a two-piece system and a barrier with a locking flange.
Modifiers may be applicable depending on the circumstances of service. Consult your local Medicare Administrative Contractor (MAC) for specific guidance.
Medical necessity for A4420 is established by the presence of an ostomy requiring waste collection and the need for a secure, hygienic, and patient-appropriate pouch system.Documentation should support the choice of this specific code considering factors like the presence of a stoma, the need for a closed-system pouch, the use of a two-piece system, and the presence of a locking flange.
The clinical responsibility lies with the healthcare professional who assesses the patient's needs for ostomy supplies and orders the appropriate type and quantity of pouches based on individual circumstances. This could be a surgeon, a wound care nurse, or an enterostomal therapist.
In simple words: This code is for a special bag used by people with ostomies.The bag is part of a two-part system and connects to a special skin barrier that keeps it securely in place.The bag is closed and must be detached to be emptied.
HCPCS code A4420 represents a closed ostomy pouch designed for use with a two-piece system.This pouch is intended to collect waste material from a stoma, a surgically created opening. The pouch connects to a barrier featuring a locking flange, which ensures a secure attachment to the skin and prevents backflow of waste.The locking mechanism allows for emptying the pouch while leaving the barrier in place, improving hygiene. Medicare coverage is dependent on factors such as ostomy type, location, construction, and the skin condition around the stoma.
Example 1: A patient undergoes a colectomy (surgical removal of part of the colon) resulting in a colostomy.The surgeon prescribes A4420 closed ostomy pouches for waste collection.The patient is instructed on proper use and emptying of the pouch., A patient with an existing ileostomy experiences leakage from their current ostomy pouch system.Their enterostomal therapist assesses the situation and determines that a change to a locking flange system (A4420) would improve the seal and reduce leakage.The new system is prescribed., During a routine follow-up appointment, a patient reports increased skin irritation around their stoma.The nurse observes that the patient’s current non-locking flange system leads to frequent pouch changes and increased skin contact with waste.A switch to a locking flange system (A4420) is recommended to improve skin hygiene and reduce irritation.
Documentation should include the type of ostomy (e.g., colostomy, ileostomy), the patient's specific needs related to output volume and skin condition, and the rationale for selecting A4420 versus alternate ostomy pouches.Physician orders for the ostomy supplies must be present in the patient's medical record.
** Always verify the specific characteristics of the ostomy pouch (e.g., closed vs. drainable, two-piece vs. one-piece, presence of a filter) to ensure accurate code selection.Refer to the most up-to-date HCPCS codebook for the latest information.
- Payment Status: Active
- Specialties:Surgery, Gastroenterology, Urology, Wound Care
- Place of Service:Office, Home Healthcare, Hospital Outpatient