A4381 HCPCS code: Ostomy pouch, urinary, for use on faceplate, plastic, each
A4381 is the HCPCS Level II code for ostomy pouch, urinary, for use on faceplate, plastic, each. The 2026 Medicare DMEPOS fee schedule pays $6.59 to $7.21 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 27% from 2022 to 2024 (4,304 to 3,137 services). In 2024, 12 suppliers billed Medicare for A4381 (purchases), serving 39 beneficiaries. Its average fee ranks 22 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 A4381
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $6.59 | $7.21 | $6.59 | $5.60 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $6.66 | — |
| AL | — | $6.59 | — |
| AR | — | $6.59 | — |
| AZ | — | $6.59 | — |
| CA | — | $6.59 | — |
| CO | — | $6.59 | — |
| CT | — | $6.59 | — |
| DC | — | $6.59 | — |
| DE | — | $6.59 | — |
| FL | — | $6.59 | — |
| GA | — | $6.59 | — |
| HI | — | $7.09 | — |
| IA | — | $6.59 | — |
| ID | — | $6.59 | — |
| IL | — | $6.59 | — |
| IN | — | $6.59 | — |
| KS | — | $6.59 | — |
| KY | — | $6.59 | — |
| LA | — | $6.59 | — |
| MA | — | $6.59 | — |
| MD | — | $6.59 | — |
| ME | — | $6.59 | — |
| MI | — | $6.59 | — |
| MN | — | $6.59 | — |
| MO | — | $6.59 | — |
| MS | — | $6.59 | — |
| MT | — | $6.59 | — |
| NC | — | $6.59 | — |
| ND | — | $6.59 | — |
| NE | — | $6.59 | — |
| NH | — | $6.59 | — |
| NJ | — | $6.59 | — |
| NM | — | $6.59 | — |
| NV | — | $6.59 | — |
| NY | — | $6.59 | — |
| OH | — | $6.59 | — |
| OK | — | $6.59 | — |
| OR | — | $6.59 | — |
| PA | — | $6.59 | — |
| PR | — | $7.21 | — |
| RI | — | $6.59 | — |
| SC | — | $6.59 | — |
| SD | — | $6.59 | — |
| TN | — | $6.59 | — |
| TX | — | $6.59 | — |
| UT | — | $6.59 | — |
| VA | — | $6.59 | — |
| VI | — | $6.59 | — |
| VT | — | $6.59 | — |
| WA | — | $6.59 | — |
| WI | — | $6.59 | — |
| WV | — | $6.59 | — |
| WY | — | $6.59 | — |
How the A4381 fee compares
| Measure | Value |
|---|---|
| Rank among 68 A43 codes (lowest = 1) | 22 |
| Family fee range (average of state fees) | $0.05–$878.06 |
| Rural fee uplift | — |
Who bills A4381 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 12 |
| Referring clinicians | 36 |
| Medicare beneficiaries | 39 |
| States with claims | 3 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 14 | 54 |
| 2023 | 13 | 50 |
| 2024 | 12 | 39 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4381, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 4,304 | 54 | $5.48 | $4.21 |
| 2023 | 3,326 | 50 | $5.76 | $4.47 |
| 2024 | 3,137 | 39 | $5.84 | $4.50 |
States with the most A4381 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 2,031 | $4.48 |
| Pennsylvania | 280 | $4.31 |
| Colorado | 220 | $4.88 |
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 A4381
- 2026-01-01: Average state fee rose 2.0%: $6.48 to $6.61
- 2000-01-01: A4381 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 A4381?
A4381 is the HCPCS Level II code for ostomy pouch, urinary, for use on faceplate, plastic, each. Short descriptor: "Urinary plastic pouch w/o fp".
How much does Medicare pay for A4381?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $6.59–$7.21. Rural fees can be higher.
Does Medicare cover A4381?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A4381?
Medicare policy articles that cite A4381 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 A4381 change in 2026?
The average non-rural state fee moved from $6.48 in 2025 to $6.61 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4381 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)
- 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 A4381
- Watch A4381 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4381
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.