2024 HCPCS Code A4417

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

Short Description	Ost pch w bar/bltinconv/fltr
HCPCS Coverage Code	C - Carrier judgment
HCPCS Action Code	N - No maintenance for this code
HCPCS Action Effective Date	January 01, 2004
HCPCS Code Added Date	January 01, 2004
HCPCS Pricing Indicator Code	37 - Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)
HCPCS Multiple Pricing Indicator Code	A - Not applicable as HCPCS priced under one methodology
HCPCS Coverage Issues Manual Reference Section Number
HCPCS Type Of Service Code	P - Lump sum purchase of DME, prosthetics, orthotics
HCPCS Anesthesia Base Unit Quantity	0