A4368 HCPCS code: Ostomy filter, any type, each
A4368 is the HCPCS Level II code for ostomy filter, any type, each. The 2026 Medicare DMEPOS fee schedule pays $0.36 to $0.39 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on outpatient hospital claims. Medicare volume fell 13% from 2022 to 2024 (10,969 to 9,535 services). In 2024, 25 suppliers billed Medicare for A4368 (purchases), serving 70 beneficiaries; Texas, California, Ohio accounted for 75% of services. Its average fee ranks 3 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 | C — Carrier judgment |
| Pricing indicator | 37 — DMEPOS: ostomy, tracheostomy and urological supplies |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1997-01-01 |
| Last action effective | 1997-01-01 |
2026 Medicare DMEPOS fee schedule for A4368
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $0.36 | $0.39 | $0.36 | $0.31 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $0.36 | — |
| AL | — | $0.36 | — |
| AR | — | $0.36 | — |
| AZ | — | $0.36 | — |
| CA | — | $0.36 | — |
| CO | — | $0.36 | — |
| CT | — | $0.36 | — |
| DC | — | $0.36 | — |
| DE | — | $0.36 | — |
| FL | — | $0.36 | — |
| GA | — | $0.36 | — |
| HI | — | $0.38 | — |
| IA | — | $0.36 | — |
| ID | — | $0.36 | — |
| IL | — | $0.36 | — |
| IN | — | $0.36 | — |
| KS | — | $0.36 | — |
| KY | — | $0.36 | — |
| LA | — | $0.36 | — |
| MA | — | $0.36 | — |
| MD | — | $0.36 | — |
| ME | — | $0.36 | — |
| MI | — | $0.36 | — |
| MN | — | $0.36 | — |
| MO | — | $0.36 | — |
| MS | — | $0.36 | — |
| MT | — | $0.36 | — |
| NC | — | $0.36 | — |
| ND | — | $0.36 | — |
| NE | — | $0.36 | — |
| NH | — | $0.36 | — |
| NJ | — | $0.36 | — |
| NM | — | $0.36 | — |
| NV | — | $0.36 | — |
| NY | — | $0.36 | — |
| OH | — | $0.36 | — |
| OK | — | $0.36 | — |
| OR | — | $0.36 | — |
| PA | — | $0.36 | — |
| PR | — | $0.39 | — |
| RI | — | $0.36 | — |
| SC | — | $0.36 | — |
| SD | — | $0.36 | — |
| TN | — | $0.36 | — |
| TX | — | $0.36 | — |
| UT | — | $0.36 | — |
| VA | — | $0.36 | — |
| VI | — | $0.36 | — |
| VT | — | $0.36 | — |
| WA | — | $0.36 | — |
| WI | — | $0.36 | — |
| WV | — | $0.36 | — |
| WY | — | $0.36 | — |
How the A4368 fee compares
| Measure | Value |
|---|---|
| Rank among 68 A43 codes (lowest = 1) | 3 |
| Family fee range (average of state fees) | $0.05–$878.06 |
| Rural fee uplift | — |
Who bills A4368 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 25 |
| Referring clinicians | 72 |
| Medicare beneficiaries | 70 |
| States with claims | 5 |
| Share of services in top 3 states (Texas, California, Ohio) | 75% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 35 | 89 |
| 2023 | 28 | 75 |
| 2024 | 25 | 70 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4368, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 10,969 | 89 | $0.30 | $0.22 |
| 2023 | 8,704 | 75 | $0.33 | $0.24 |
| 2024 | 9,535 | 70 | $0.34 | $0.25 |
States with the most A4368 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 1,435 | $0.26 |
| California | 1,020 | $0.25 |
| Ohio | 840 | $0.27 |
| North Dakota | 640 | $0.27 |
| Minnesota | 450 | $0.27 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Clinical: CMS Workgroup |
| practitioner claims | 1 | Clinical: Data |
Medicare policy articles for this code
- A52487: Ostomy Supplies - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (10 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| K94.00 | Colostomy complication, unspecified | 1 |
| K94.03 | Colostomy malfunction | 1 |
| K94.10 | Enterostomy complication, unspecified | 1 |
| K94.13 | Enterostomy malfunction | 1 |
| Z43.2 | Encounter for attention to ileostomy | 1 |
| Z43.3 | Encounter for attention to colostomy | 1 |
| Z43.6 | Encounter for attention to other artificial openings of urinary tract | 1 |
| Z93.2 | Ileostomy status | 1 |
| Z93.3 | Colostomy status | 1 |
| Z93.6 | Other artificial openings of urinary tract status | 1 |
What changed for A4368
- 2026-01-01: Average state fee rose 2.8%: $0.35 to $0.36
- 1997-01-01: A4368 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 A4368?
A4368 is the HCPCS Level II code for ostomy filter, any type, each. Short descriptor: "Ostomy filter".
How much does Medicare pay for A4368?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $0.36–$0.39. Rural fees can be higher.
Does Medicare cover A4368?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for A4368?
Medicare policy articles that cite A4368 list 10 covered ICD-10-CM diagnosis codes across 1 article. The most cited include K94.00 (Colostomy complication, unspecified), K94.03 (Colostomy malfunction), K94.10 (Enterostomy complication, unspecified). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for A4368 change in 2026?
The average non-rural state fee moved from $0.35 in 2025 to $0.36 in 2026 (+2.8%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4368 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner 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 A4368
- Watch A4368 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4368
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.