ActiveLife One-Piece Convex Drainable Pouch
ConvatecPouches1-pieceDrainableConvex
- Brand
- Convatec
- Category
- Pouches
- System
- 1-piece
- Pouch type
- Drainable
- Barrier type
- Convex (from product name)
- Opening
- Pre-cut
- Filter
- Not found in our sources
- Box quantity
- 5
- Flange sizes
- Not found in our sources
- HCPCS code(s)
- A4390 (Convatec product page (ordering table))
- Lowest cash price seen
- No sourced price yet
- Source
- convatec.com · 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.
| Code | Description / size | Box | HCPCS | Price seen |
|---|---|---|---|---|
175777 | Pre-cut, Convex Durahesive Skin Barrier with tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | A4390 | — |
175778 | Pre-cut, Convex Durahesive Skin Barrier with tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | A4390 | — |
175779 | Pre-cut, Convex Durahesive Skin Barrier with tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | A4390 | — |
175780 | Pre-cut, Convex Durahesive Skin Barrier with tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | A4390 | — |
175781 | Pre-cut, Convex Durahesive Skin Barrier with tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | A4390 | — |
175782 | Pre-cut, Convex Durahesive Skin Barrier with tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | A4390 | — |
175783 | Pre-cut, Convex Durahesive Skin Barrier with tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | A4390 | — |
175784 | Pre-cut, Convex Durahesive Skin Barrier with tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | A4390 | — |
175785 | Pre-cut, Convex Durahesive Skin Barrier with tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | A4390 | — |
Medicare usual maximums for these codes
- A4390: Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each. No usual maximum is listed for this code in the LCD table.
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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