ActiveLife One-Piece Convex Urostomy Pouch
ConvatecPouches1-pieceUrostomyConvex
- Brand
- Convatec
- Category
- Pouches
- System
- 1-piece
- Pouch type
- Urostomy
- Barrier type
- Convex (from product name)
- Opening
- Pre-cut
- Filter
- Not found in our sources
- Box quantity
- 5, 10
- Flange sizes
- Not found in our sources
- HCPCS code(s)
- A4393 (Convatec product page (ordering table))
- Lowest cash price seen
- From $110.00 / Box of 10 ($11.00 each)
Vitality Medical, Nov 4, 2026 - 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. The retailer page says the manufacturer labels this item Rx only.
| Code | Description / size | Box | HCPCS | Price seen |
|---|---|---|---|---|
125361 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 10 per box | A4393 | $114.87 / Box of 10 Vitality Medical · Nov 4, 2026 |
125362 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 10 per box | A4393 | $114.87 / Box of 10 Vitality Medical · Nov 4, 2026 |
125363 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 10 per box | A4393 | $114.87 / Box of 10 Vitality Medical · Nov 4, 2026 |
125364 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 10 per box | A4393 | — |
125365 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 10 per box | A4393 | $138.39 / Box of 10 Vitality Medical · Nov 4, 2026 |
125366 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 10 per box | A4393 | $114.87 / Box of 10 Vitality Medical · Nov 4, 2026 |
125367 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 10 per box | A4393 | $115.51 / Box of 10 Vitality Medical · Nov 4, 2026 |
125368 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 10 per box | A4393 | $110.00 / Box of 10 Vitality Medical · Nov 4, 2026 |
125369 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 10 per box | A4393 | $115.51 / Box of 10 Vitality Medical · Nov 4, 2026 |
175790 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 5 per box | A4393 | $62.71 / Box of 5 Vitality Medical · Nov 4, 2026 |
175791 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 5 per box | A4393 | — |
175792 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 5 per box | A4393 | $61.04 / Box of 5 Vitality Medical · Nov 4, 2026 |
175793 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 5 per box | $60.60 / Box of 5 Vitality Medical · Nov 4, 2026 | |
175794 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 5 per box | $61.81 / Box of 5 Vitality Medical · Nov 4, 2026 | |
175795 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 5 per box | $94.25 / Box of 5 Vitality Medical · Nov 4, 2026 | |
175796 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 5 per box | $62.71 / Box of 5 Vitality Medical · Nov 4, 2026 | |
175797 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 5 per box | $62.71 / Box of 5 Vitality Medical · Nov 4, 2026 | |
175798 | Pre-cut, Convex Durahesive Skin Barrier; 8" pouch with fold over tap — Transparent | 5 per box | A4393 | $62.65 / Box of 5 Vitality Medical · Nov 4, 2026 |
Medicare usual maximums for these codes
- A4393: Ostomy pouch, urinary, 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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