New Image Two-Piece Closed Mini Ostomy Pouch
- Brand
- Hollister
- Category
- Pouches
- System
- 2-piece
- Pouch type
- Closed
- Barrier type
- Not found in our sources
- Opening
- Not found in our sources
- Filter
- Not found in our sources
- Box quantity
- 30, 60
- Flange sizes
- 25 Inch Flange, 75 Inch Flange, Flange 1 3/4 inch
- HCPCS code(s)
- A5054 (Hollister product page)
- Lowest cash price seen
- From $103.05 / Box of 60 ($1.72 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 |
|---|---|---|---|---|
18352 | Green, 1.75 Inch Flange Description from Vitality Medical listing | Box of 30 | A5054 | $54.89 / Box of 30 Vitality Medical · Nov 4, 2026 |
18353 | Red, 2.25 Inch Flange Description from Vitality Medical listing | Box of 30 | A5054 | $58.21 / Box of 30 Vitality Medical · Nov 4, 2026 |
18354 | Blue, 2.75 Inch Flange Description from Vitality Medical listing | Box of 30 | A5054 | $54.89 / Box of 30 Vitality Medical · Nov 4, 2026 |
18752 | Color Code (G), Flange 1 3/4 inch, Length 7 inch Color Beigestyle Description from Vitality Medical listing | Box of 60 | A5054 | $103.05 / Box of 60 Vitality Medical · Nov 4, 2026 |
18753 | Red, 2.25 Inch Flange Description from Vitality Medical listing | Box of 60 | A5054 | $109.80 / Box of 60 Vitality Medical · Nov 4, 2026 |
Medicare usual maximums for these codes
- A5054: Ostomy pouch, closed; for use on barrier with flange (2 piece), each. Usual maximum in LCD L33828: 60 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
- Beige pouch flange
- Odor-barrier pouch film
- Anatomical pouch shape
- Designed to be used with any New Image two-piece skin barrier with same flange size
As described on the source page.
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