New Image Two-Piece Drainable Ostomy Pouch – Clamp Closure
HollisterPouches2-pieceDrainable
- Brand
- Hollister
- Category
- Pouches
- System
- 2-piece
- Pouch type
- Drainable
- Barrier type
- Not found in our sources
- Opening
- Pre-cut
- Filter
- Not found in our sources
- Box quantity
- 10
- Flange sizes
- Flange 1 3/4 Inch, Flange 2 1/4 Inch, Flange 2 3/4 Inch, Flange 4 Inch
- HCPCS code(s)
- A5063 (Hollister product page)
- Lowest cash price seen
- From $29.90 / Box of 10 ($2.99 each)
Vitality Medical, Nov 4, 2026 - Source
- hollister.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 |
|---|---|---|---|---|
18102 | Green Color Match, Flange 1 3/4 Inch, Transparent Description from Vitality Medical listing | Box of 10 | A5063 | $32.22 / Box of 10 Vitality Medical · Nov 4, 2026 |
18103 | Red Color Match, Flange 2 1/4 Inch, Transparent Description from Vitality Medical listing | Box of 10 | A5063 | $29.90 / Box of 10 Vitality Medical · Nov 4, 2026 |
18104 | Blue Color Match, Flange 2 3/4 Inch, Transparent Description from Vitality Medical listing | Box of 10 | A5063 | $30.29 / Box of 10 Vitality Medical · Nov 4, 2026 |
18122 | Green Color Match, Flange 1 3/4 Inch, Beige Description from Vitality Medical listing | Box of 10 | A5063 | $31.56 / Box of 10 Vitality Medical · Nov 4, 2026 |
18123 | Red Color Match, Flange 2 1/4 Inch, Beige Description from Vitality Medical listing | Box of 10 | A5063 | $31.70 / Box of 10 Vitality Medical · Nov 4, 2026 |
18124 | Blue Color Match, Flange 2 3/4 Inch, Beige Description from Vitality Medical listing | Box of 10 | A5063 | $32.15 / Box of 10 Vitality Medical · Nov 4, 2026 |
18172 | Stoma Size: 1-3/16 Inch, Convex, 8-1/2 Inch Length, Pre-Cut Description from Vitality Medical listing | Box of 10 | A5063 | $41.13 / Box of 10 Vitality Medical · Nov 4, 2026$30.45 / Box of 10 Vitality Medical · Nov 4, 2026 |
18173 | Stoma Size: 1-3/8 Inch, Concave Description from Vitality Medical listing | Box of 10 | A5063 | $40.00 / Box of 10 Vitality Medical · Nov 4, 2026$31.70 / Box of 10 Vitality Medical · Nov 4, 2026 |
18174 | Blue Color Match, Flange 2 3/4 Inch, Beige Description from Vitality Medical listing | Box of 10 | A5063 | $32.22 / Box of 10 Vitality Medical · Nov 4, 2026 |
18176 | Yellow Color Match, Flange 4 Inch, Ultra-Clear Description from Vitality Medical listing | Box of 10 | A5063 | $40.19 / Box of 10 Vitality Medical · Nov 4, 2026 |
Medicare usual maximums for these codes
- A5063: Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each. Usual maximum in LCD L33828: 20 per month.
From our Medicare guide (LCD L33828). Informational only; coverage depends on your plan and documentation. Confirm with your supplier or plan.
Manufacturer-listed features
- Curved, beige pouch clamp
- Beige pouch flange
- Odor-barrier pouch film
- Designed to be used with any New Image two-piece skin barrier with same flange size
- Belt tabs
- Transparent and Ultra-Clear — body side only
As described on the source page.
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