ActiveLife One-Piece Drainable Pouch
ConvatecPouches1-pieceDrainableFlat
- Brand
- Convatec
- Category
- Pouches
- System
- 1-piece
- Pouch type
- Drainable
- Barrier type
- Flat (from product name)
- Opening
- Cut-to-fit, Pre-cut
- Filter
- Not found in our sources
- Box quantity
- 5, 10, 20
- Flange sizes
- Not found in our sources
- HCPCS code(s)
- A4388, A5061 (Convatec product page (ordering table))
- Lowest cash price seen
- From $88.38 / Box of 20 ($4.42 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 |
|---|---|---|---|---|
125330 | Cut-to-fit, Stomahesive Skin Barrier with tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 20 per box | A5061 | $88.38 / Box of 20 Vitality Medical · Nov 4, 2026 |
400598 | Cut-to-fit, Durahesive Plus Skin Barrier with tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 10 per box | A4388 | — |
400599 | Cut-to-fit, Durahesive Plus Skin Barrier with tape collar; 12" pouch with 1-sided comfort panel and tail clip — Opaque | 10 per box | A4388 | — |
125331 | Pre-cut, Stomahesive Skin Barrier and tape collar; 10" pouch with 1-sided comfort panel and tail clip — Opaque | 20 per box | A5061 | — |
125333 | Pre-cut, Stomahesive Skin Barrier and tape collar; 10" pouch with 1-sided comfort panel and tail clip — Opaque | 20 per box | A5061 | — |
125334 | Pre-cut, Stomahesive Skin Barrier and tape collar; 10" pouch with 1-sided comfort panel and tail clip — Opaque | 20 per box | A5061 | — |
125335 | Pre-cut, Stomahesive Skin Barrier and tape collar; 10" pouch with 1-sided comfort panel and tail clip — Opaque | 20 per box | A5061 | — |
125336 | Pre-cut, Stomahesive Skin Barrier and tape collar; 10" pouch with 1-sided comfort panel and tail clip — Opaque | 20 per box | A5061 | — |
125337 | Pre-cut, Stomahesive Skin Barrier and tape collar; 10" pouch with 1-sided comfort panel and tail clip — Opaque | 20 per box | A5061 | — |
022750 | Pre-cut, Stomahesive Skin Barrier and tape collar; 10" pouch with 1-sided comfort panel and tail clip — Opaque | 10 per box | A5061 | — |
022751 | Pre-cut, Stomahesive Skin Barrier and tape collar; 10" pouch with 1-sided comfort panel and tail clip — Opaque | 10 per box | A5061 | — |
022752 | Pre-cut, Stomahesive Skin Barrier and tape collar; 10" pouch with 1-sided comfort panel and tail clip — Opaque | 10 per box | A5061 | — |
022753 | Pre-cut, Stomahesive Skin Barrier and tape collar; 10" pouch with 1-sided comfort panel and tail clip — Opaque | 10 per box | A5061 | — |
022755 | Pre-cut, Stomahesive Skin Barrier and tape collar; 10" pouch with 1-sided comfort panel and tail clip — Opaque | 10 per box | A5061 | — |
022756 | Pre-cut, Stomahesive Skin Barrier and tape collar; 10" pouch with 1-sided comfort panel and tail clip — Opaque | 10 per box | A5061 | — |
125338 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Opaque | 20 per box | A5061 | — |
125339 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Opaque | 20 per box | A5061 | — |
125340 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Opaque | 20 per box | A5061 | — |
125341 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Opaque | 20 per box | A5061 | — |
125342 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Opaque | 20 per box | A5061 | — |
125343 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Opaque | 20 per box | A5061 | — |
125344 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Opaque | 20 per box | A5061 | — |
022757 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Opaque | 10 per box | A5061 | — |
022766 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 10 per box | A5061 | — |
022767 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 10 per box | A5061 | — |
022765 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 10 per box | — | |
022764 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 10 per box | — | |
022758 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 10 per box | $48.12 / Box of 10 Vitality Medical · Nov 4, 2026 | |
175785 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | — | |
175784 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | — | |
175783 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | — | |
175782 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | — | |
175781 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | — | |
175780 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | — | |
175779 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | — | |
175778 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | — | |
175777 | Pre-cut, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 5 per box | — | |
025433 | Cut-to-fit, Stomahesive Skin Barrier and tape collar; 12" pouch with 1-sided comfort panel and tail clip — Transparent | 1perbox | — |
Medicare usual maximums for these codes
- A4388: Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each. No usual maximum is listed for this code in the LCD table.
- A5061: Ostomy pouch, drainable; with barrier attached, (1 piece), 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.
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