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Assura Convex Deep 1-piece drainable pouch

Coloplast Pouches 1-piece Drainable Convex

Brand: Coloplast
Category: Pouches
System: 1-piece
Pouch type: Drainable
Barrier type: Convex (from product name)
Opening: Not found in our sources
Filter: No
Box quantity: 10
Flange sizes: Not found in our sources
HCPCS code(s): A4389, A4390 (Coloplast product page (variant name))
Lowest cash price seen: From $38.97 / Box of 5 ($7.79 each)
Vitality Medical, Nov 4, 2026
Source: products.coloplast.us · 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
`12416`	XPRO -Maxi (11 1/4in/530mL)- Stoma size:15-43mm \|5/8-1 11/16in-no filter, Transparent	10 per box	A4390	—
`12419`	XPRO - Maxi (11 1/4in/530mL) - Stoma size: 15-43mm \| 5/8 - 1 11/16in - no filter, Opaque	10 per box	A4390	—
`12533`	Maxi (11 1/4in / 530mL) - Stoma size: 15-43mm \| 5/8 - 1 11/16in - no filter Opaque	10 per box	A4389	—
`13703`	Midi (9 3/4in / 230mL)- Stoma size: 15-43mm \| 5/8 - 1 11/16in - no filter Transparent	10 per box	A4389	—
`13706`	Maxi(11 1/4in / 530mL) - Stoma size:15-43mm \| 5/8 - 1 11/16in- no filter, Transparent	10 per box	A4389	—
`14103`	Maxi (11 1/4in / 530mL) - Stoma size: 15-43mm \| 5/8 - 1 11/16in, Transparent	10 per box	A4389	$38.97 / Box of 5 Vitality Medical · Nov 4, 2026
`14106`	Maxi (11 1/4in / 530mL) - Stoma size: 15-43mm \| 5/8 - 1 11/16in, Opaque	10 per box	A4389	—
`14163`	Maxi (11 1/4in / 530mL) - Stoma size: 21mm \| 7/8in Transparent	10 per box	A4389	—
`14164`	Maxi (11 1/4in / 530mL) - Stoma size: 25mm \| 1in, Transparent	10 per box	A4389	—
`14165`	Maxi (11 1/4in / 530mL) - Stoma size: 28mm \| 1 1/8in Transparent	10 per box	A4389	—
`14166`	Maxi (11 1/4in / 530mL) - Stoma size: 31mm \| 1 1/4in, Transparent	10 per box	A4389	—
`14173`	Maxi (11 1/4in / 530mL) - Stoma size: 22mm \| 7/8in, Opaque	10 per box	A4389	—
`14175`	Maxi (11 1/4in / 530mL) - Stoma size: 28mm \| 1 1/8in, Opaque	10 per box	A4389	—
`14176`	Maxi (11 1/4in / 530mL) - Stoma size: 31mm \| 1 1/4in Opaque	10 per box	A4389	—
`14196`	Midi (10 1/4in / 390mL) - Stoma size: 15-43mm \| 5/8 - 1 11/16in, Opaque	10 per box	A4389	—

Medicare usual maximums for these codes

A4389: Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each. No usual maximum is listed for this code in the LCD table.
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.