A4434 HCPCS code: Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each
A4434 is the HCPCS Level II code for ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each. The 2026 Medicare DMEPOS fee schedule pays $5.36 to $5.93 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 13% from 2022 to 2024 (5,010 to 4,350 services). In 2024, 17 suppliers billed Medicare for A4434 (purchases), serving 58 beneficiaries. Its average fee ranks 21 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 A4434
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $5.36 | $5.93 | $5.36 | $4.56 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $5.36 | — |
| AL | — | $5.36 | — |
| AR | — | $5.36 | — |
| AZ | — | $5.36 | — |
| CA | — | $5.36 | — |
| CO | — | $5.36 | — |
| CT | — | $5.36 | — |
| DC | — | $5.36 | — |
| DE | — | $5.36 | — |
| FL | — | $5.36 | — |
| GA | — | $5.36 | — |
| HI | — | $5.36 | — |
| IA | — | $5.36 | — |
| ID | — | $5.36 | — |
| IL | — | $5.36 | — |
| IN | — | $5.36 | — |
| KS | — | $5.36 | — |
| KY | — | $5.36 | — |
| LA | — | $5.36 | — |
| MA | — | $5.36 | — |
| MD | — | $5.36 | — |
| ME | — | $5.36 | — |
| MI | — | $5.36 | — |
| MN | — | $5.36 | — |
| MO | — | $5.36 | — |
| MS | — | $5.36 | — |
| MT | — | $5.36 | — |
| NC | — | $5.36 | — |
| ND | — | $5.36 | — |
| NE | — | $5.36 | — |
| NH | — | $5.36 | — |
| NJ | — | $5.36 | — |
| NM | — | $5.36 | — |
| NV | — | $5.36 | — |
| NY | — | $5.36 | — |
| OH | — | $5.36 | — |
| OK | — | $5.36 | — |
| OR | — | $5.36 | — |
| PA | — | $5.36 | — |
| PR | — | $5.93 | — |
| RI | — | $5.36 | — |
| SC | — | $5.36 | — |
| SD | — | $5.36 | — |
| TN | — | $5.36 | — |
| TX | — | $5.36 | — |
| UT | — | $5.36 | — |
| VA | — | $5.36 | — |
| VI | — | $5.36 | — |
| VT | — | $5.36 | — |
| WA | — | $5.36 | — |
| WI | — | $5.36 | — |
| WV | — | $5.36 | — |
| WY | — | $5.36 | — |
How the A4434 fee compares
| Measure | Value |
|---|---|
| Rank among 42 A44 codes (lowest = 1) | 21 |
| Family fee range (average of state fees) | $0.15–$160.42 |
| Rural fee uplift | — |
Who bills A4434 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 17 |
| Referring clinicians | 54 |
| Medicare beneficiaries | 58 |
| States with claims | 4 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 7 | 62 |
| 2023 | 6 | 55 |
| 2024 | 17 | 58 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4434, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 5,010 | 62 | $4.59 | $3.41 |
| 2023 | 4,230 | 55 | $4.95 | $3.58 |
| 2024 | 4,350 | 58 | $5.12 | $3.78 |
States with the most A4434 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Arkansas | 2,640 | $3.71 |
| Louisiana | 310 | $3.84 |
| Mississippi | 280 | $3.87 |
| Texas | 260 | $4.02 |
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 A4434
- 2026-01-01: Average state fee rose 2.1%: $5.26 to $5.37
- 2004-01-01: A4434 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 A4434?
A4434 is the HCPCS Level II code for ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each. Short descriptor: "Ost pch urine w lock flng/ft".
How much does Medicare pay for A4434?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $5.36–$5.93. Rural fees can be higher.
Does Medicare cover A4434?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for A4434 change in 2026?
The average non-rural state fee moved from $5.26 in 2025 to $5.37 in 2026 (+2.1%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4434 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 A4434
- Watch A4434 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4434
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.