A4375 HCPCS code: Ostomy pouch, drainable, with faceplate attached, plastic, each
A4375 is the HCPCS Level II code for ostomy pouch, drainable, with faceplate attached, plastic, each. The 2026 Medicare DMEPOS fee schedule pays $24.47 to $26.91 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 2 per day on outpatient hospital claims. Medicare volume fell 22% from 2022 to 2024 (20,126 to 15,626 services). In 2024, 11 suppliers billed Medicare for A4375 (purchases), serving 125 beneficiaries; Florida, Georgia, Virginia accounted for 78% of services. Its average fee ranks 50 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 | 2000-01-01 |
| Last action effective | 2003-01-01 |
2026 Medicare DMEPOS fee schedule for A4375
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $24.47 | $26.91 | $24.47 | $20.80 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $24.68 | — |
| AL | — | $24.47 | — |
| AR | — | $24.47 | — |
| AZ | — | $24.47 | — |
| CA | — | $24.47 | — |
| CO | — | $24.47 | — |
| CT | — | $24.47 | — |
| DC | — | $24.47 | — |
| DE | — | $24.47 | — |
| FL | — | $24.47 | — |
| GA | — | $24.47 | — |
| HI | — | $26.42 | — |
| IA | — | $24.47 | — |
| ID | — | $24.47 | — |
| IL | — | $24.47 | — |
| IN | — | $24.47 | — |
| KS | — | $24.47 | — |
| KY | — | $24.47 | — |
| LA | — | $24.47 | — |
| MA | — | $24.47 | — |
| MD | — | $24.47 | — |
| ME | — | $24.47 | — |
| MI | — | $24.47 | — |
| MN | — | $24.47 | — |
| MO | — | $24.47 | — |
| MS | — | $24.47 | — |
| MT | — | $24.47 | — |
| NC | — | $24.47 | — |
| ND | — | $24.47 | — |
| NE | — | $24.47 | — |
| NH | — | $24.47 | — |
| NJ | — | $24.47 | — |
| NM | — | $24.47 | — |
| NV | — | $24.47 | — |
| NY | — | $24.47 | — |
| OH | — | $24.47 | — |
| OK | — | $24.47 | — |
| OR | — | $24.47 | — |
| PA | — | $24.47 | — |
| PR | — | $26.91 | — |
| RI | — | $24.47 | — |
| SC | — | $24.47 | — |
| SD | — | $24.47 | — |
| TN | — | $24.47 | — |
| TX | — | $24.47 | — |
| UT | — | $24.47 | — |
| VA | — | $24.47 | — |
| VI | — | $24.47 | — |
| VT | — | $24.47 | — |
| WA | — | $24.47 | — |
| WI | — | $24.47 | — |
| WV | — | $24.47 | — |
| WY | — | $24.47 | — |
How the A4375 fee compares
| Measure | Value |
|---|---|
| Rank among 68 A43 codes (lowest = 1) | 50 |
| Family fee range (average of state fees) | $0.05–$878.06 |
| Rural fee uplift | — |
Who bills A4375 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 11 |
| Referring clinicians | 113 |
| Medicare beneficiaries | 125 |
| States with claims | 10 |
| Share of services in top 3 states (Florida, Georgia, Virginia) | 78% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 23 | 165 |
| 2023 | 15 | 153 |
| 2024 | 11 | 125 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4375, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 20,126 | 165 | $18.30 | $14.17 |
| 2023 | 19,053 | 153 | $18.84 | $14.55 |
| 2024 | 15,626 | 125 | $18.96 | $14.61 |
States with the most A4375 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 8,540 | $14.04 |
| Georgia | 2,020 | $17.35 |
| Virginia | 720 | $14.50 |
| New York | 700 | $14.71 |
| Texas | 700 | $16.72 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Clinical: CMS Workgroup |
| practitioner claims | 2 | Clinical: CMS Workgroup |
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 A4375
- 2026-01-01: Average state fee rose 2.0%: $24.08 to $24.56
- 2000-01-01: A4375 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 A4375?
A4375 is the HCPCS Level II code for ostomy pouch, drainable, with faceplate attached, plastic, each. Short descriptor: "Drainable plastic pch w fcpl".
How much does Medicare pay for A4375?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $24.47–$26.91. Rural fees can be higher.
Does Medicare cover A4375?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A4375?
Medicare policy articles that cite A4375 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 A4375 change in 2026?
The average non-rural state fee moved from $24.08 in 2025 to $24.56 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4375 can be billed per day?
2 on outpatient hospital claims; 2 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)
- 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 A4375
- Watch A4375 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4375
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.