A4357 HCPCS code: Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each
A4357 is the HCPCS Level II code for bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each. The 2026 Medicare DMEPOS fee schedule pays $11.76 to $15.39 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 6 per day on DME suppliers. Medicare volume fell 8% from 2022 to 2024 (619,742 to 570,641 services). In 2024, 1,973 suppliers billed Medicare for A4357 (purchases), serving 62,945 beneficiaries; Florida, New York, California accounted for 22% of services. Its average fee ranks 38 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 | 1985-01-01 |
| Last action effective | 1996-01-01 |
2026 Medicare DMEPOS fee schedule for A4357
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $11.76 | $15.39 | $13.84 | $11.76 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $14.40 | — |
| AL | — | $13.84 | — |
| AR | — | $13.84 | — |
| AZ | — | $13.77 | — |
| CA | — | $13.84 | — |
| CO | — | $13.84 | — |
| CT | — | $13.30 | — |
| DC | — | $13.11 | — |
| DE | — | $13.11 | — |
| FL | — | $13.84 | — |
| GA | — | $11.76 | — |
| HI | — | $15.39 | — |
| IA | — | $13.01 | — |
| ID | — | $11.76 | — |
| IL | — | $13.84 | — |
| IN | — | $13.84 | — |
| KS | — | $13.61 | — |
| KY | — | $11.76 | — |
| LA | — | $13.84 | — |
| MA | — | $11.76 | — |
| MD | — | $13.84 | — |
| ME | — | $11.76 | — |
| MI | — | $13.84 | — |
| MN | — | $13.84 | — |
| MO | — | $13.84 | — |
| MS | — | $11.76 | — |
| MT | — | $11.76 | — |
| NC | — | $13.84 | — |
| ND | — | $13.84 | — |
| NE | — | $13.52 | — |
| NH | — | $13.84 | — |
| NJ | — | $13.11 | — |
| NM | — | $11.76 | — |
| NV | — | $13.84 | — |
| NY | — | $13.84 | — |
| OH | — | $13.84 | — |
| OK | — | $11.76 | — |
| OR | — | $13.84 | — |
| PA | — | $13.11 | — |
| PR | — | $13.96 | — |
| RI | — | $11.76 | — |
| SC | — | $13.84 | — |
| SD | — | $13.84 | — |
| TN | — | $11.76 | — |
| TX | — | $11.76 | — |
| UT | — | $11.76 | — |
| VA | — | $12.26 | — |
| VI | — | $13.84 | — |
| VT | — | $11.76 | — |
| WA | — | $13.84 | — |
| WI | — | $13.84 | — |
| WV | — | $13.84 | — |
| WY | — | $13.84 | — |
How the A4357 fee compares
| Measure | Value |
|---|---|
| Rank among 68 A43 codes (lowest = 1) | 38 |
| Family fee range (average of state fees) | $0.05–$878.06 |
| Rural fee uplift | — |
Who bills A4357 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 1,973 |
| Referring clinicians | 32,506 |
| Medicare beneficiaries | 62,945 |
| States with claims | 55 |
| Share of services in top 3 states (Florida, New York, California) | 22% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 2,279 | 70,229 |
| 2023 | 2,114 | 66,729 |
| 2024 | 1,973 | 62,945 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4357, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 619,742 | 70,229 | $11.33 | $8.43 |
| 2023 | 591,366 | 66,729 | $12.31 | $9.14 |
| 2024 | 570,641 | 62,945 | $12.65 | $9.43 |
States with the most A4357 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 42,443 | $9.91 |
| New York | 40,515 | $9.79 |
| California | 40,010 | $9.84 |
| Texas | 31,892 | $8.47 |
| Pennsylvania | 31,312 | $9.43 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 6 | 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 A4357
- 2026-01-01: Average state fee rose 2.0%: $12.95 to $13.21
- 1985-01-01: A4357 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 A4357?
A4357 is the HCPCS Level II code for bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each. Short descriptor: "Bedside drainage bag".
How much does Medicare pay for A4357?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $11.76–$15.39. Rural fees can be higher.
Does Medicare cover A4357?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A4357?
Medicare policy articles that cite A4357 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 A4357 change in 2026?
The average non-rural state fee moved from $12.95 in 2025 to $13.21 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4357 can be billed per day?
6 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)
- A4320 — Irrigation tray with bulb or piston syringe, any purpose ($6.34–$8.42)
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 A4357
- Watch A4357 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4357
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.