A4312 HCPCS code: Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone
A4312 is the HCPCS Level II code for insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone. The 2026 Medicare DMEPOS fee schedule pays $21.85 to $36.59 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 3 per day on DME suppliers. Medicare volume fell 32% from 2022 to 2024 (2,397 to 1,634 services). In 2024, 107 suppliers billed Medicare for A4312 (purchases), serving 353 beneficiaries; California, Florida, New York accounted for 33% of services. Its average fee ranks 51 of 68 A43 codes (family range $0.05–$878.06).
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 37 — DMEPOS: ostomy, tracheostomy and urological supplies |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1990-01-01 |
| Last action effective | 1990-01-01 |
2026 Medicare DMEPOS fee schedule for A4312
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $21.85 | $36.59 | $25.70 | $21.85 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $33.37 | — |
| AL | — | $22.15 | — |
| AR | — | $25.70 | — |
| AZ | — | $25.70 | — |
| CA | — | $25.70 | — |
| CO | — | $21.85 | — |
| CT | — | $21.85 | — |
| DC | — | $21.85 | — |
| DE | — | $21.85 | — |
| FL | — | $25.70 | — |
| GA | — | $21.85 | — |
| HI | — | $35.70 | — |
| IA | — | $25.70 | — |
| ID | — | $21.85 | — |
| IL | — | $25.70 | — |
| IN | — | $25.70 | — |
| KS | — | $25.70 | — |
| KY | — | $25.20 | — |
| LA | — | $25.70 | — |
| MA | — | $21.85 | — |
| MD | — | $21.85 | — |
| ME | — | $21.85 | — |
| MI | — | $25.70 | — |
| MN | — | $25.70 | — |
| MO | — | $25.70 | — |
| MS | — | $25.70 | — |
| MT | — | $23.73 | — |
| NC | — | $25.70 | — |
| ND | — | $22.87 | — |
| NE | — | $25.70 | — |
| NH | — | $21.85 | — |
| NJ | — | $21.85 | — |
| NM | — | $25.70 | — |
| NV | — | $25.70 | — |
| NY | — | $21.85 | — |
| OH | — | $25.70 | — |
| OK | — | $25.70 | — |
| OR | — | $21.85 | — |
| PA | — | $21.85 | — |
| PR | — | $36.59 | — |
| RI | — | $21.85 | — |
| SC | — | $25.70 | — |
| SD | — | $22.87 | — |
| TN | — | $25.70 | — |
| TX | — | $25.70 | — |
| UT | — | $25.70 | — |
| VA | — | $21.85 | — |
| VI | — | $21.85 | — |
| VT | — | $21.85 | — |
| WA | — | $24.45 | — |
| WI | — | $25.70 | — |
| WV | — | $25.70 | — |
| WY | — | $23.43 | — |
How the A4312 fee compares
| Measure | Value |
|---|---|
| Rank among 68 A43 codes (lowest = 1) | 51 |
| Family fee range (average of state fees) | $0.05–$878.06 |
| Rural fee uplift | — |
Who bills A4312 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 107 |
| Referring clinicians | 360 |
| Medicare beneficiaries | 353 |
| States with claims | 22 |
| Share of services in top 3 states (California, Florida, New York) | 33% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 121 | 613 |
| 2023 | 124 | 514 |
| 2024 | 107 | 353 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4312, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 2,397 | 613 | $20.77 | $15.02 |
| 2023 | 2,137 | 514 | $22.21 | $16.22 |
| 2024 | 1,634 | 353 | $23.33 | $17.08 |
States with the most A4312 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 189 | $17.20 |
| Florida | 141 | $16.81 |
| New York | 99 | $14.86 |
| Texas | 95 | $18.61 |
| Missouri | 90 | $18.65 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 3 | Published Contractor Policy |
| outpatient hospital claims | 1 | Clinical: Data |
Medicare policy articles for this code
- A52521: Urological Supplies - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (1 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| N39.3 | Stress incontinence (female) (male) | 1 |
What changed for A4312
- 2026-01-01: Average state fee rose 2.0%: $24.16 to $24.64
- 1990-01-01: A4312 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code A4312?
A4312 is the HCPCS Level II code for insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone. Short descriptor: "Cath w/o bag 2-way silicone".
How much does Medicare pay for A4312?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $21.85–$36.59. Rural fees can be higher.
Does Medicare cover A4312?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A4312?
Medicare policy articles that cite A4312 list 1 covered ICD-10-CM diagnosis codes across 1 article. The most cited include N39.3 (Stress incontinence (female) (male)). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for A4312 change in 2026?
The average non-rural state fee moved from $24.16 in 2025 to $24.64 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4312 can be billed per day?
3 on DME suppliers; 1 on outpatient hospital claims (NCCI medically unlikely edits).
Related A43 codes
- A4300 — Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access
- A4301 — Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.)
- A4305 — Disposable drug delivery system, flow rate of 50 ml or greater per hour
- A4306 — Disposable drug delivery system, flow rate of less than 50 ml per hour
- A4310 — Insertion tray without drainage bag and without catheter (accessories only) ($9.36–$25.22)
- A4311 — Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) ($16.05–$28.00)
- A4313 — Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation ($22.44–$40.49)
- A4314 — Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) ($30.63–$41.77)
- A4315 — Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone ($31.95–$48.37)
- A4316 — Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation ($34.40–$48.37)
- A4320 — Irrigation tray with bulb or piston syringe, any purpose ($6.34–$8.42)
- A4321 — Therapeutic agent for urinary catheter irrigation
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under A4312
- Watch A4312 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4312
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.