A4426 HCPCS code: Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each

A4426 is the HCPCS Level II code for ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each. The 2026 Medicare DMEPOS fee schedule pays $3.89 to $4.66 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 rose 2% from 2022 to 2024 (50,509 to 51,309 services). In 2024, 113 suppliers billed Medicare for A4426 (purchases), serving 486 beneficiaries; Texas, Florida, Pennsylvania accounted for 20% of services. Its average fee ranks 12 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 A4426

Modifier	Meaning	Lowest state fee	Highest state fee	Ceiling	Floor
—	base fee	$3.89	$4.66	$3.89	$3.31

State	Modifier	Fee	Rural fee
AK	—	$3.89	—
AL	—	$3.89	—
AR	—	$3.89	—
AZ	—	$3.89	—
CA	—	$3.89	—
CO	—	$3.89	—
CT	—	$3.89	—
DC	—	$3.89	—
DE	—	$3.89	—
FL	—	$3.89	—
GA	—	$3.89	—
HI	—	$3.89	—
IA	—	$3.89	—
ID	—	$3.89	—
IL	—	$3.89	—
IN	—	$3.89	—
KS	—	$3.89	—
KY	—	$3.89	—
LA	—	$3.89	—
MA	—	$3.89	—
MD	—	$3.89	—
ME	—	$3.89	—
MI	—	$3.89	—
MN	—	$3.89	—
MO	—	$3.89	—
MS	—	$3.89	—
MT	—	$3.89	—
NC	—	$3.89	—
ND	—	$3.89	—
NE	—	$3.89	—
NH	—	$3.89	—
NJ	—	$3.89	—
NM	—	$3.89	—
NV	—	$3.89	—
NY	—	$3.89	—
OH	—	$3.89	—
OK	—	$3.89	—
OR	—	$3.89	—
PA	—	$3.89	—
PR	—	$4.66	—
RI	—	$3.89	—
SC	—	$3.89	—
SD	—	$3.89	—
TN	—	$3.89	—
TX	—	$3.89	—
UT	—	$3.89	—
VA	—	$3.89	—
VI	—	$3.89	—
VT	—	$3.89	—
WA	—	$3.89	—
WI	—	$3.89	—
WV	—	$3.89	—
WY	—	$3.89	—

How the A4426 fee compares

Measure	Value
Rank among 42 A44 codes (lowest = 1)	12
Family fee range (average of state fees)	$0.15–$160.42
Rural fee uplift	—

Who bills A4426 (2024)

Measure	Value
Suppliers billing rentals	—
Suppliers billing purchases	113
Referring clinicians	506
Medicare beneficiaries	486
States with claims	36
Share of services in top 3 states (Texas, Florida, Pennsylvania)	20%

Year	Suppliers	Beneficiaries
2022	114	453
2023	110	447
2024	113	486

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

Medicare utilization for A4426, 2022–2024

Year	Services	Beneficiaries	Avg. allowed	Avg. paid
2022	50,509	453	$3.33	$2.51
2023	46,372	447	$3.61	$2.72
2024	51,309	486	$3.71	$2.79

States with the most A4426 services (2024)

State	Services	Avg. paid
Texas	3,830	$2.77
Florida	3,130	$2.78
Pennsylvania	2,910	$2.84
New York	2,630	$2.80
California	2,470	$2.72

NCCI unit limits (MUE)

Claim type	Max units per day	Rationale
outpatient hospital claims	2	Clinical: CMS Workgroup
practitioner claims	2	Clinical: CMS Workgroup

What changed for A4426

2026-01-01: Average state fee rose 2.1%: $3.82 to $3.90
2004-01-01: A4426 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 A4426?

A4426 is the HCPCS Level II code for ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each. Short descriptor: "Ost pch drain 2 piece system".

How much does Medicare pay for A4426?

Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $3.89–$4.66. Rural fees can be higher.

Does Medicare cover A4426?

Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.

Did the Medicare fee for A4426 change in 2026?

The average non-rural state fee moved from $3.82 in 2025 to $3.90 in 2026 (+2.1%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.

How many units of A4426 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)

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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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