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

HCPCS code

Name of the Procedure:

Ostomy Pouch, Closed; For Use on Barrier with Flange (2 Piece), HCPCS Code A5054


An ostomy pouch is a medical device used by individuals who have undergone colostomy, ileostomy, or urostomy surgery. This closed pouch attaches to a barrier with a flange in a two-piece system, allowing for the collection of waste materials from the body's stoma.


This procedure addresses the management of waste for patients with a stoma due to conditions such as colorectal cancer, inflammatory bowel disease, or certain injuries. The primary goal is to provide an effective and hygienic method for waste collection, enhancing the patient's quality of life and maintaining skin health around the stoma.


  • Post-surgical patients with a colostomy, ileostomy, or urostomy
  • Individuals experiencing frequent leakage or skin irritation from one-piece systems
  • Patients requiring a more discreet and convenient ostomy management solution


  • No specific fasting or medication adjustments are typically required.
  • Patients may undergo a consultation to select the most appropriate size and type of ostomy pouch.
  • Skin preparation might involve cleaning and drying the peristomal skin area.

Procedure Description

  1. Clean the Stoma Area: Gently clean the stoma and surrounding skin with water and dry thoroughly.
  2. Prepare the Barrier: Cut the barrier opening to fit the stoma size, ensuring a secure and snug fit to prevent leakage.
  3. Attach the Barrier: Apply the barrier with flange onto the clean, dry skin surrounding the stoma.
  4. Attach the Pouch: Snap the closed ostomy pouch onto the flange of the barrier, ensuring it is securely connected.
  5. Check for Leaks: Ensure there are no gaps or leaks around the flange.

Tools and equipment include an ostomy pouch, flange, barrier rings/seals, and medical adhesive. No anesthesia or sedation is required for the application.


The application typically takes about 15-20 minutes. The pouch can be worn for several days, depending on the individual’s needs and comfort.


This procedure can be performed in various settings including at home, in outpatient clinics, and hospitals.


  • Ostomy care nurse or healthcare provider for initial training
  • The patient or caregiver for routine application and management

Risks and Complications

  • Common Risks: Skin irritation, leakage, odor.
  • Rare Risks: Allergic reactions to barrier materials, infection around the stoma. Management includes regular skin care, changing the pouch as needed, and seeking medical advice if complications arise.


  • Enhanced comfort and convenience in managing stoma output.
  • Improved skin health and reduced leakage.
  • Greater discretion and confidence in daily activities. Benefits are immediate following proper application.


  • Post-procedure care: Regular cleaning of the stoma site and timely changing of the pouch.
  • Recovery time: No recovery time needed; patients can resume normal activities immediately.
  • Restrictions: Avoiding activities that may dislodge the pouch or irritate the stoma site.
  • Follow-up: Routine check-ups with healthcare provider as needed.


  • One-piece ostomy systems: Pros include a simpler application process; cons include more frequent changes.
  • Irrigation methods: Pros include less frequent appliance use; cons include the need for more time and effort. Consult with healthcare provider to determine the best option.

Patient Experience

  • During procedure: Minimal discomfort as no invasive steps are involved.
  • Post-procedure: Patients might experience an adjustment period with some skin sensitivity.
  • Pain Management: Generally, no pain management is necessary. Any irritation can be managed with skin barrier creams or adhesives.

Medical Policies and Guidelines for Ostomy pouch, closed; for use on barrier with flange (2 piece), each

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