A4390 HCPCS code: Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each
A4390 is the HCPCS Level II code for ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each. The 2026 Medicare DMEPOS fee schedule pays $13.68 to $15.03 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 1 per day on outpatient hospital claims. Medicare volume fell 21% from 2022 to 2024 (518,825 to 411,124 services). In 2024, 512 suppliers billed Medicare for A4390 (purchases), serving 3,910 beneficiaries; California, Illinois, Florida accounted for 19% of services. Its average fee ranks 39 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 A4390
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $13.68 | $15.03 | $13.68 | $11.63 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $13.85 | — |
| AL | — | $13.68 | — |
| AR | — | $13.68 | — |
| AZ | — | $13.68 | — |
| CA | — | $13.68 | — |
| CO | — | $13.68 | — |
| CT | — | $13.68 | — |
| DC | — | $13.68 | — |
| DE | — | $13.68 | — |
| FL | — | $13.68 | — |
| GA | — | $13.68 | — |
| HI | — | $14.82 | — |
| IA | — | $13.68 | — |
| ID | — | $13.68 | — |
| IL | — | $13.68 | — |
| IN | — | $13.68 | — |
| KS | — | $13.68 | — |
| KY | — | $13.68 | — |
| LA | — | $13.68 | — |
| MA | — | $13.68 | — |
| MD | — | $13.68 | — |
| ME | — | $13.68 | — |
| MI | — | $13.68 | — |
| MN | — | $13.68 | — |
| MO | — | $13.68 | — |
| MS | — | $13.68 | — |
| MT | — | $13.68 | — |
| NC | — | $13.68 | — |
| ND | — | $13.68 | — |
| NE | — | $13.68 | — |
| NH | — | $13.68 | — |
| NJ | — | $13.68 | — |
| NM | — | $13.68 | — |
| NV | — | $13.68 | — |
| NY | — | $13.68 | — |
| OH | — | $13.68 | — |
| OK | — | $13.68 | — |
| OR | — | $13.68 | — |
| PA | — | $13.68 | — |
| PR | — | $15.03 | — |
| RI | — | $13.68 | — |
| SC | — | $13.68 | — |
| SD | — | $13.68 | — |
| TN | — | $13.68 | — |
| TX | — | $13.68 | — |
| UT | — | $13.68 | — |
| VA | — | $13.68 | — |
| VI | — | $13.68 | — |
| VT | — | $13.68 | — |
| WA | — | $13.68 | — |
| WI | — | $13.68 | — |
| WV | — | $13.68 | — |
| WY | — | $13.68 | — |
How the A4390 fee compares
| Measure | Value |
|---|---|
| Rank among 68 A43 codes (lowest = 1) | 39 |
| Family fee range (average of state fees) | $0.05–$878.06 |
| Rural fee uplift | — |
Who bills A4390 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 512 |
| Referring clinicians | 3,929 |
| Medicare beneficiaries | 3,910 |
| States with claims | 51 |
| Share of services in top 3 states (California, Illinois, Florida) | 19% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 621 | 4,843 |
| 2023 | 573 | 4,322 |
| 2024 | 512 | 3,910 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4390, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 518,825 | 4,843 | $11.68 | $8.84 |
| 2023 | 452,551 | 4,322 | $12.70 | $9.60 |
| 2024 | 411,124 | 3,910 | $13.03 | $9.89 |
States with the most A4390 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 39,589 | $9.95 |
| Illinois | 20,320 | $9.87 |
| Florida | 19,618 | $10.03 |
| Ohio | 19,184 | $9.95 |
| New York | 19,175 | $10.00 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Clinical: CMS Workgroup |
| practitioner claims | 1 | Clinical: CMS Workgroup |
What changed for A4390
- 2026-01-01: Average state fee rose 2.0%: $13.46 to $13.73
- 2000-01-01: A4390 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 A4390?
A4390 is the HCPCS Level II code for ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each. Short descriptor: "Drainable pch ex wear convex".
How much does Medicare pay for A4390?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $13.68–$15.03. Rural fees can be higher.
Does Medicare cover A4390?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for A4390 change in 2026?
The average non-rural state fee moved from $13.46 in 2025 to $13.73 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4390 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 A4390
- Watch A4390 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4390
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.