A4409 HCPCS code: Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each

A4409 is the HCPCS Level II code for ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each. The 2026 Medicare DMEPOS fee schedule pays $8.84 to $10.60 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 5% from 2022 to 2024 (4,058,097 to 3,837,489 services). In 2024, 1,497 suppliers billed Medicare for A4409 (purchases), serving 36,636 beneficiaries; California, Florida, New York accounted for 21% of services. Its average fee ranks 30 of 42 A44 codes (family range $0.15–$160.42).

Code details

2026 Medicare DMEPOS fee schedule for A4409

How the A4409 fee compares

Who bills A4409 (2024)

Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.

Medicare utilization for A4409, 2022–2024

States with the most A4409 services (2024)

NCCI unit limits (MUE)

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:

What changed for A4409

• 2026-01-01: Average state fee rose 2.0%: $8.70 to $8.87
• 2003-01-01: A4409 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 A4409?

A4409 is the HCPCS Level II code for ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each. Short descriptor: "Ost skn barr convex <=4 sq i".

How much does Medicare pay for A4409?

Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $8.84–$10.60. Rural fees can be higher.

Does Medicare cover A4409?

Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.

Which diagnoses support coverage for A4409?

Medicare policy articles that cite A4409 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 A4409 change in 2026?

The average non-rural state fee moved from $8.70 in 2025 to $8.87 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.

How many units of A4409 can be billed per day?

1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).

Related A44 codes

• A4400 — Ostomy irrigation set ($59.20–$90.97)
• A4402 — Lubricant, per ounce ($1.93–$5.70)
• A4404 — Ostomy ring, each ($2.03–$2.60)
• A4405 — Ostomy skin barrier, non-pectin based, paste, per ounce ($4.87–$5.76)
• A4406 — Ostomy skin barrier, pectin-based, paste, per ounce ($8.16–$9.78)
• A4407 — Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each ($12.48–$14.94)
• A4408 — Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each ($14.07–$16.87)
• A4410 — Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each ($12.88–$15.43)
• A4411 — Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each ($7.26–$8.70)
• A4412 — Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each ($3.86–$4.56)
• A4413 — Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each ($7.85–$9.44)
• A4414 — Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each ($7.01–$8.39)

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Next steps

• Run a reimbursement report for a device billed under A4409
• Watch A4409 for fee, coverage and descriptor changes
• Build a full Medicare revenue model for A4409

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.

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