Assura 2-piece closed pouch
- Brand
- Coloplast
- Category
- Pouches
- System
- 2-piece
- Pouch type
- Closed
- Barrier type
- Not found in our sources
- Opening
- Not found in our sources
- Filter
- Yes
- Box quantity
- 30
- Flange sizes
- Coupling Blue, Coupling Green, Coupling Red
- HCPCS code(s)
- A4423, A5055 (Coloplast product page (variant name))
- Lowest cash price seen
- From $64.04 / Box of 30 ($2.13 each)
Vitality Medical, Nov 4, 2026 - Source
- products.coloplast.us · checked Nov 4, 2026
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Sizes, codes and prices
Prices are cash prices one retailer listed on the date shown, per the retailer's unit. Retailer links are marked as sponsored for search engines and may become affiliate links later. We do not take referral fees from suppliers that bill Medicare. The retailer page says the manufacturer labels this item Rx only.
| Code | Description / size | Box | HCPCS | Price seen |
|---|---|---|---|---|
2801 | Minicap 2-piece - Coupling: Green - with filter, Opaque | 30 per box | A5055 | — |
2802 | Minicap 2-piece - Coupling: Red - with filter Opaque | 30 per box | A5055 | — |
2803 | Stoma Cap - Coupling: Blue - with filter, Opaque | 30 per box | A5055 | — |
12344 | Midi (7in / 275mL) - Coupling: Green Transparent | 30 per box | A4423 | $70.37 / Box of 30 Vitality Medical · Nov 4, 2026 |
12345 | Midi (7in / 275mL) - Coupling: Red Transparent | 30 per box | A4423 | $68.91 / Box of 30 Vitality Medical · Nov 4, 2026 |
12346 | Midi (7in / 275mL) - Coupling: Blue, Transparent | 30 per box | A4423 | $64.04 / Box of 30 Vitality Medical · Nov 4, 2026 |
12354 | Midi (7in / 275mL) - Coupling: Green Opaque | 30 per box | A4423 | $64.55 / Box of 30 Vitality Medical · Nov 4, 2026 |
12355 | Midi (7in / 275mL) - Coupling: Red, Opaque | 30 per box | A4423 | $68.91 / Box of 30 Vitality Medical · Nov 4, 2026 |
12356 | Midi (7in / 275mL) - Coupling: Blue, Opaque | 30 per box | A4423 | $68.91 / Box of 30 Vitality Medical · Nov 4, 2026 |
12374 | Maxi (8 1/2in / 570mL) - Coupling: Green, Transparent | 30 per box | A4423 | $64.04 / Box of 30 Vitality Medical · Nov 4, 2026 |
12375 | Maxi (8 1/2in / 570mL) - Coupling: Red, Transparent | 30 per box | A4423 | $68.91 / Box of 30 Vitality Medical · Nov 4, 2026 |
12376 | Maxi (8 1/2in / 570mL) - Coupling: Blue Transparent | 30 per box | A4423 | $64.04 / Box of 30 Vitality Medical · Nov 4, 2026 |
12384 | Maxi (8 1/2in / 570mL) - Coupling: Green Opaque | 30 per box | A4423 | $68.91 / Box of 30 Vitality Medical · Nov 4, 2026 |
12385 | Maxi (8 1/2in / 570mL) - Coupling: Red Opaque | 30 per box | A4423 | $69.28 / Box of 30 Vitality Medical · Nov 4, 2026 |
12386 | Maxi (8 1/2in / 570mL) - Coupling: Blue Opaque | 30 per box | A4423 | $70.37 / Box of 30 Vitality Medical · Nov 4, 2026 |
Medicare usual maximums for these codes
- A4423: Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each. Usual maximum in LCD L33828: 60 per month.
- A5055: Stoma cap. Usual maximum in LCD L33828: 31 per month.
From our Medicare guide (LCD L33828). Informational only; coverage depends on your plan and documentation. Confirm with your supplier or plan.
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