A4391 – Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each

HCPCS Level II code · A codes: Transportation, Medical & Surgical Supplies, Miscellaneous & Experimental

Active code Special coverage instructions apply

HCPCS codeA4391
Long description
Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each
Short description
Urinary pouch w ex wear barr
Pricing indicator
37 Ostomy, tracheostomy and urological supplies
Medicare coverage
D Special coverage instructions apply
BETOS category
D1F Prosthetic/Orthotic devices
Added
January 1, 2000
Last change
January 1, 2003 – No change

Frequently asked questions

What is HCPCS code A4391?

A4391 is a HCPCS Level II code for ostomy pouch, urinary, with extended wear barrier attached (1 piece), each.

Does Medicare cover A4391?

The HCPCS file lists coverage code D: Special coverage instructions apply. Coverage and payment also depend on local coverage determinations and the patient’s plan.

Nearby A codes

Source: CMS HCPCS Level II quarterly file, October 2026. Reference only – check payer policy before billing.