A4433 HCPCS code: Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each
A4433 is the HCPCS Level II code for ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each. The 2026 Medicare DMEPOS fee schedule pays $4.78 to $5.20 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 rose 5% from 2022 to 2024 (135,565 to 141,814 services). In 2024, 183 suppliers billed Medicare for A4433 (purchases), serving 1,332 beneficiaries; Pennsylvania, California, Florida accounted for 25% of services. Its average fee ranks 16 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 A4433
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $4.78 | $5.20 | $4.78 | $4.06 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $4.78 | — |
| AL | — | $4.78 | — |
| AR | — | $4.78 | — |
| AZ | — | $4.78 | — |
| CA | — | $4.78 | — |
| CO | — | $4.78 | — |
| CT | — | $4.78 | — |
| DC | — | $4.78 | — |
| DE | — | $4.78 | — |
| FL | — | $4.78 | — |
| GA | — | $4.78 | — |
| HI | — | $4.78 | — |
| IA | — | $4.78 | — |
| ID | — | $4.78 | — |
| IL | — | $4.78 | — |
| IN | — | $4.78 | — |
| KS | — | $4.78 | — |
| KY | — | $4.78 | — |
| LA | — | $4.78 | — |
| MA | — | $4.78 | — |
| MD | — | $4.78 | — |
| ME | — | $4.78 | — |
| MI | — | $4.78 | — |
| MN | — | $4.78 | — |
| MO | — | $4.78 | — |
| MS | — | $4.78 | — |
| MT | — | $4.78 | — |
| NC | — | $4.78 | — |
| ND | — | $4.78 | — |
| NE | — | $4.78 | — |
| NH | — | $4.78 | — |
| NJ | — | $4.78 | — |
| NM | — | $4.78 | — |
| NV | — | $4.78 | — |
| NY | — | $4.78 | — |
| OH | — | $4.78 | — |
| OK | — | $4.78 | — |
| OR | — | $4.78 | — |
| PA | — | $4.78 | — |
| PR | — | $5.20 | — |
| RI | — | $4.78 | — |
| SC | — | $4.78 | — |
| SD | — | $4.78 | — |
| TN | — | $4.78 | — |
| TX | — | $4.78 | — |
| UT | — | $4.78 | — |
| VA | — | $4.78 | — |
| VI | — | $4.78 | — |
| VT | — | $4.78 | — |
| WA | — | $4.78 | — |
| WI | — | $4.78 | — |
| WV | — | $4.78 | — |
| WY | — | $4.78 | — |
How the A4433 fee compares
| Measure | Value |
|---|---|
| Rank among 42 A44 codes (lowest = 1) | 16 |
| Family fee range (average of state fees) | $0.15–$160.42 |
| Rural fee uplift | — |
Who bills A4433 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 183 |
| Referring clinicians | 1,250 |
| Medicare beneficiaries | 1,332 |
| States with claims | 48 |
| Share of services in top 3 states (Pennsylvania, California, Florida) | 25% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 165 | 1,272 |
| 2023 | 173 | 1,289 |
| 2024 | 183 | 1,332 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4433, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 135,565 | 1,272 | $4.09 | $3.12 |
| 2023 | 132,440 | 1,289 | $4.45 | $3.39 |
| 2024 | 141,814 | 1,332 | $4.57 | $3.48 |
States with the most A4433 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Pennsylvania | 14,120 | $3.44 |
| California | 11,591 | $3.46 |
| Florida | 10,300 | $3.50 |
| Texas | 8,055 | $3.54 |
| New York | 6,485 | $3.46 |
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 A4433
- 2026-01-01: Average state fee rose 1.9%: $4.70 to $4.79
- 2004-01-01: A4433 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 A4433?
A4433 is the HCPCS Level II code for ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each. Short descriptor: "Urine ost pch bar w lock fln".
How much does Medicare pay for A4433?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $4.78–$5.20. Rural fees can be higher.
Does Medicare cover A4433?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for A4433 change in 2026?
The average non-rural state fee moved from $4.70 in 2025 to $4.79 in 2026 (+1.9%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4433 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)
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Next steps
- Run a reimbursement report for a device billed under A4433
- Watch A4433 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4433
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.