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Ostomy Supplies (CPB 0906, reviewed 2025-12-22)

Aetna·General Surgery, Urology, Wound Care +1 more·Medical Policy
Effective date
Dec 22, 2025
We identified it
Aug 13, 2026
Days to comply

Summary

Aetna has issued a comprehensive medical policy (CPB 0906) establishing medical necessity criteria and monthly/semi-annual quantity limits for ostomy supplies across all ostomy types (colostomy, ileostomy, urinary ostomy). The policy specifies maximum allowable units per item, requires documentation to justify quantities exceeding limits, and restricts certain combinations (e.g., no dual use of liquid barriers, no concurrent day/night drainage bags). Claims exceeding documented medical necessity will be denied.

Action Required

Action needed
By December 22, 2025 (effective immediately): Billing team must implement quantity limits in billing software for all ostomy HCPCS codes (A4331-A4409) per Table 1 (monthly) and Table 2 (semi-annual) limits. Update billing system to: (1) flag claims exceeding maximums for review; (2) require providers to submit medical necessity documentation for quantities above limits before claim submission; (3) deny or pend claims lacking documented justification. Notify providers that documentation must clearly justify excess quantities based on stoma type, location, construction, and skin condition. Train front-desk and billing staff on quantity restrictions and the prohibition of dual-use items (e.g., cannot bill both liquid and spray barriers, cannot bill both day and night drainage bags on same day for urinary ostomies). Update encounter forms to include ostomy-specific medical history fields. Failure to implement will result in claim denials and compliance violations.

Affected Billing Codes

A4331
A4357
A4361
A4362
A4363
A4364
A4366
A4367
A4368
A4369
A4371
A4372
A4373
A4375
A4376
A4377
A4378
A4379
A4380
A4381
A4382
A4383
A4384
A4385
A4387
A4388
A4389
A4390
A4391
A4392
A4393
A4394
A4395
A4396
A4398
A4399
A4402
A4404
A4405
A4406
A4407
A4408
A4409