Esteem synergy+ Adhesive Coupling Technology Drainable Pouch
ConvatecPouches2-pieceDrainable
- Brand
- Convatec
- Category
- Pouches
- System
- 2-piece
- Pouch type
- Drainable
- Barrier type
- Not found in our sources
- Opening
- Not found in our sources
- Filter
- No
- Box quantity
- 10
- Flange sizes
- Not found in our sources
- HCPCS code(s)
- A4425, A5063 (Convatec product page (ordering table))
- Lowest cash price seen
- No sourced price yet
- 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.
| Code | Description / size | Box | HCPCS | Price seen |
|---|---|---|---|---|
416901 | 12" pouch with 1-sided comfort panel, InvisiClose Tail Closure and filter — Transparent | 10 per box | A4425 | — |
416795 | 12" pouch with 1-sided comfort panel, InvisiClose Tail Closure and filter — Transparent | 10 per box | A4425 | — |
416796 | 12" pouch with 2-sided comfort panel, InvisiClose Tail Closure and filter — Opaque | 10 per box | A4425 | — |
416798 | 12" pouch with 1-sided comfort panel, InvisiClose Tail Closure and filter — Transparent | 10 per box | A4425 | — |
416799 | 12" pouch with 2-sided comfort panel, InvisiClose Tail Closure and filter — Opaque | 10 per box | A4425 | — |
416902 | 12" pouch with 2-sided comfort panel, InvisiClose Tail Closure and filter — Opaque | 10 per box | A4425 | — |
416903 | 12" pouch with 1-sided comfort panel, InvisiClose Tail Closure; no filter — Transparent | 10 per box | A5063 | — |
Medicare usual maximums for these codes
- A4425: Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each. Usual maximum in LCD L33828: 20 per month.
- 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.
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