A4416 HCPCS code: Ostomy pouch, closed, with barrier attached, with filter (1 piece), each
A4416 is the HCPCS Level II code for ostomy pouch, closed, with barrier attached, with filter (1 piece), each. The 2026 Medicare DMEPOS fee schedule pays $3.93 to $4.35 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 2 per day on outpatient hospital claims. Medicare volume fell 13% from 2022 to 2024 (1,167,652 to 1,014,232 services). In 2024, 350 suppliers billed Medicare for A4416 (purchases), serving 2,587 beneficiaries; California, New York, Florida accounted for 22% of services. Its average fee ranks 13 of 42 A44 codes (family range $0.15–$160.42).
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 | 2004-01-01 |
| Last action effective | 2004-01-01 |
2026 Medicare DMEPOS fee schedule for A4416
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $3.93 | $4.35 | $3.93 | $3.34 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $3.93 | — |
| AL | — | $3.93 | — |
| AR | — | $3.93 | — |
| AZ | — | $3.93 | — |
| CA | — | $3.93 | — |
| CO | — | $3.93 | — |
| CT | — | $3.93 | — |
| DC | — | $3.93 | — |
| DE | — | $3.93 | — |
| FL | — | $3.93 | — |
| GA | — | $3.93 | — |
| HI | — | $3.93 | — |
| IA | — | $3.93 | — |
| ID | — | $3.93 | — |
| IL | — | $3.93 | — |
| IN | — | $3.93 | — |
| KS | — | $3.93 | — |
| KY | — | $3.93 | — |
| LA | — | $3.93 | — |
| MA | — | $3.93 | — |
| MD | — | $3.93 | — |
| ME | — | $3.93 | — |
| MI | — | $3.93 | — |
| MN | — | $3.93 | — |
| MO | — | $3.93 | — |
| MS | — | $3.93 | — |
| MT | — | $3.93 | — |
| NC | — | $3.93 | — |
| ND | — | $3.93 | — |
| NE | — | $3.93 | — |
| NH | — | $3.93 | — |
| NJ | — | $3.93 | — |
| NM | — | $3.93 | — |
| NV | — | $3.93 | — |
| NY | — | $3.93 | — |
| OH | — | $3.93 | — |
| OK | — | $3.93 | — |
| OR | — | $3.93 | — |
| PA | — | $3.93 | — |
| PR | — | $4.35 | — |
| RI | — | $3.93 | — |
| SC | — | $3.93 | — |
| SD | — | $3.93 | — |
| TN | — | $3.93 | — |
| TX | — | $3.93 | — |
| UT | — | $3.93 | — |
| VA | — | $3.93 | — |
| VI | — | $3.93 | — |
| VT | — | $3.93 | — |
| WA | — | $3.93 | — |
| WI | — | $3.93 | — |
| WV | — | $3.93 | — |
| WY | — | $3.93 | — |
How the A4416 fee compares
| Measure | Value |
|---|---|
| Rank among 42 A44 codes (lowest = 1) | 13 |
| Family fee range (average of state fees) | $0.15–$160.42 |
| Rural fee uplift | — |
Who bills A4416 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 350 |
| Referring clinicians | 2,643 |
| Medicare beneficiaries | 2,587 |
| States with claims | 51 |
| Share of services in top 3 states (California, New York, Florida) | 22% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 425 | 2,905 |
| 2023 | 390 | 2,677 |
| 2024 | 350 | 2,587 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4416, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,167,652 | 2,905 | $3.36 | $2.53 |
| 2023 | 1,054,193 | 2,677 | $3.65 | $2.73 |
| 2024 | 1,014,232 | 2,587 | $3.75 | $2.82 |
States with the most A4416 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 85,600 | $2.81 |
| New York | 79,117 | $2.80 |
| Florida | 59,885 | $2.85 |
| Texas | 51,141 | $2.83 |
| New Jersey | 51,040 | $2.84 |
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 A4416
- 2026-01-01: Average state fee rose 2.1%: $3.86 to $3.94
- 2004-01-01: A4416 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 A4416?
A4416 is the HCPCS Level II code for ostomy pouch, closed, with barrier attached, with filter (1 piece), each. Short descriptor: "Ost pch clsd w barrier/filtr".
How much does Medicare pay for A4416?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $3.93–$4.35. Rural fees can be higher.
Does Medicare cover A4416?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for A4416?
Medicare policy articles that cite A4416 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 A4416 change in 2026?
The average non-rural state fee moved from $3.86 in 2025 to $3.94 in 2026 (+2.1%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4416 can be billed per day?
2 on outpatient hospital claims; 2 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)
- A4409 — Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each ($8.84–$10.60)
- 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)
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 A4416
- Watch A4416 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4416
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.