A4354 HCPCS code: Insertion tray with drainage bag but without catheter
A4354 is the HCPCS Level II code for insertion tray with drainage bag but without catheter. The 2026 Medicare DMEPOS fee schedule pays $14.31 to $27.31 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 14% from 2022 to 2024 (7,929 to 6,820 services). In 2024, 199 suppliers billed Medicare for A4354 (purchases), serving 1,867 beneficiaries; Pennsylvania, North Carolina, California accounted for 24% of services. Its average fee ranks 43 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 | 1986-01-01 |
| Last action effective | 1990-01-01 |
2026 Medicare DMEPOS fee schedule for A4354
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $14.31 | $27.31 | $16.83 | $14.31 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $25.52 | — |
| AL | — | $16.83 | — |
| AR | — | $16.83 | — |
| AZ | — | $16.83 | — |
| CA | — | $16.83 | — |
| CO | — | $16.83 | — |
| CT | — | $16.83 | — |
| DC | — | $16.66 | — |
| DE | — | $16.66 | — |
| FL | — | $14.31 | — |
| GA | — | $14.31 | — |
| HI | — | $27.31 | — |
| IA | — | $16.83 | — |
| ID | — | $15.82 | — |
| IL | — | $16.83 | — |
| IN | — | $16.59 | — |
| KS | — | $16.83 | — |
| KY | — | $16.83 | — |
| LA | — | $16.83 | — |
| MA | — | $16.83 | — |
| MD | — | $14.49 | — |
| ME | — | $16.83 | — |
| MI | — | $14.50 | — |
| MN | — | $16.83 | — |
| MO | — | $16.83 | — |
| MS | — | $16.83 | — |
| MT | — | $14.31 | — |
| NC | — | $16.83 | — |
| ND | — | $14.31 | — |
| NE | — | $16.83 | — |
| NH | — | $14.31 | — |
| NJ | — | $16.66 | — |
| NM | — | $15.42 | — |
| NV | — | $16.83 | — |
| NY | — | $14.31 | — |
| OH | — | $16.83 | — |
| OK | — | $16.16 | — |
| OR | — | $14.31 | — |
| PA | — | $16.66 | — |
| PR | — | $25.22 | — |
| RI | — | $16.83 | — |
| SC | — | $16.83 | — |
| SD | — | $16.47 | — |
| TN | — | $16.83 | — |
| TX | — | $16.83 | — |
| UT | — | $14.31 | — |
| VA | — | $14.31 | — |
| VI | — | $14.31 | — |
| VT | — | $14.31 | — |
| WA | — | $14.31 | — |
| WI | — | $16.59 | — |
| WV | — | $16.83 | — |
| WY | — | $14.31 | — |
How the A4354 fee compares
| Measure | Value |
|---|---|
| Rank among 68 A43 codes (lowest = 1) | 43 |
| Family fee range (average of state fees) | $0.05–$878.06 |
| Rural fee uplift | — |
Who bills A4354 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 199 |
| Referring clinicians | 1,648 |
| Medicare beneficiaries | 1,867 |
| States with claims | 45 |
| Share of services in top 3 states (Pennsylvania, North Carolina, California) | 24% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 197 | 2,250 |
| 2023 | 187 | 1,769 |
| 2024 | 199 | 1,867 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4354, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 7,929 | 2,250 | $13.82 | $10.11 |
| 2023 | 6,951 | 1,769 | $15.08 | $11.05 |
| 2024 | 6,820 | 1,867 | $15.46 | $11.69 |
States with the most A4354 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Pennsylvania | 687 | $11.89 |
| North Carolina | 499 | $12.51 |
| California | 407 | $12.19 |
| New York | 405 | $10.32 |
| Minnesota | 305 | $12.24 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 3 | Published Contractor Policy |
| outpatient hospital claims | 2 | 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 A4354
- 2026-01-01: Average state fee rose 2.0%: $16.23 to $16.56
- 1986-01-01: A4354 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 A4354?
A4354 is the HCPCS Level II code for insertion tray with drainage bag but without catheter. Short descriptor: "Cath insertion tray w/bag".
How much does Medicare pay for A4354?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $14.31–$27.31. Rural fees can be higher.
Does Medicare cover A4354?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A4354?
Medicare policy articles that cite A4354 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 A4354 change in 2026?
The average non-rural state fee moved from $16.23 in 2025 to $16.56 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4354 can be billed per day?
3 on DME suppliers; 2 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)
- A4312 — Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone ($21.85–$36.59)
- 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)
- A4318 — Female external urinary collection cup, with or without ring attachment, per day
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 A4354
- Watch A4354 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4354
Sources: CMS HCPCS Level II release October 2026; 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.