A4425 HCPCS code: Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each
A4425 is the HCPCS Level II code for ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each. The 2026 Medicare DMEPOS fee schedule pays $5.10 to $5.61 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 1 per day on outpatient hospital claims. Medicare volume fell 4% from 2022 to 2024 (3,323,817 to 3,193,601 services). In 2024, 1,299 suppliers billed Medicare for A4425 (purchases), serving 28,442 beneficiaries; California, Florida, New York accounted for 21% of services. Its average fee ranks 18 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 A4425
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $5.10 | $5.61 | $5.10 | $4.34 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $5.10 | — |
| AL | — | $5.10 | — |
| AR | — | $5.10 | — |
| AZ | — | $5.10 | — |
| CA | — | $5.10 | — |
| CO | — | $5.10 | — |
| CT | — | $5.10 | — |
| DC | — | $5.10 | — |
| DE | — | $5.10 | — |
| FL | — | $5.10 | — |
| GA | — | $5.10 | — |
| HI | — | $5.10 | — |
| IA | — | $5.10 | — |
| ID | — | $5.10 | — |
| IL | — | $5.10 | — |
| IN | — | $5.10 | — |
| KS | — | $5.10 | — |
| KY | — | $5.10 | — |
| LA | — | $5.10 | — |
| MA | — | $5.10 | — |
| MD | — | $5.10 | — |
| ME | — | $5.10 | — |
| MI | — | $5.10 | — |
| MN | — | $5.10 | — |
| MO | — | $5.10 | — |
| MS | — | $5.10 | — |
| MT | — | $5.10 | — |
| NC | — | $5.10 | — |
| ND | — | $5.10 | — |
| NE | — | $5.10 | — |
| NH | — | $5.10 | — |
| NJ | — | $5.10 | — |
| NM | — | $5.10 | — |
| NV | — | $5.10 | — |
| NY | — | $5.10 | — |
| OH | — | $5.10 | — |
| OK | — | $5.10 | — |
| OR | — | $5.10 | — |
| PA | — | $5.10 | — |
| PR | — | $5.61 | — |
| RI | — | $5.10 | — |
| SC | — | $5.10 | — |
| SD | — | $5.10 | — |
| TN | — | $5.10 | — |
| TX | — | $5.10 | — |
| UT | — | $5.10 | — |
| VA | — | $5.10 | — |
| VI | — | $5.10 | — |
| VT | — | $5.10 | — |
| WA | — | $5.10 | — |
| WI | — | $5.10 | — |
| WV | — | $5.10 | — |
| WY | — | $5.10 | — |
How the A4425 fee compares
| Measure | Value |
|---|---|
| Rank among 42 A44 codes (lowest = 1) | 18 |
| Family fee range (average of state fees) | $0.15–$160.42 |
| Rural fee uplift | — |
Who bills A4425 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 1,299 |
| Referring clinicians | 22,391 |
| Medicare beneficiaries | 28,442 |
| States with claims | 54 |
| Share of services in top 3 states (California, Florida, New York) | 21% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 1,450 | 29,878 |
| 2023 | 1,394 | 28,981 |
| 2024 | 1,299 | 28,442 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4425, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 3,323,817 | 29,878 | $4.37 | $3.32 |
| 2023 | 3,219,614 | 28,981 | $4.74 | $3.60 |
| 2024 | 3,193,601 | 28,442 | $4.87 | $3.70 |
States with the most A4425 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 260,648 | $3.70 |
| Florida | 213,108 | $3.74 |
| New York | 200,043 | $3.72 |
| Texas | 156,810 | $3.70 |
| Pennsylvania | 141,302 | $3.67 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Clinical: CMS Workgroup |
| practitioner claims | 1 | 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 A4425
- 2026-01-01: Average state fee rose 2.0%: $5.01 to $5.11
- 2004-01-01: A4425 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 A4425?
A4425 is the HCPCS Level II code for ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each. Short descriptor: "Ost pch drain for barrier fl".
How much does Medicare pay for A4425?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $5.10–$5.61. Rural fees can be higher.
Does Medicare cover A4425?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for A4425?
Medicare policy articles that cite A4425 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 A4425 change in 2026?
The average non-rural state fee moved from $5.01 in 2025 to $5.11 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4425 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)
- 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 A4425
- Watch A4425 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4425
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.