A4435 HCPCS code: Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each
A4435 is the HCPCS Level II code for ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each. The 2026 Medicare DMEPOS fee schedule pays $8.21 to $9.31 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 101% from 2022 to 2024 (3,162 to 6,359 services). In 2024, 43 suppliers billed Medicare for A4435 (purchases), serving 116 beneficiaries; Illinois, Michigan, Missouri accounted for 34% of services. Its average fee ranks 27 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 | 2013-01-01 |
| Last action effective | 2013-01-01 |
2026 Medicare DMEPOS fee schedule for A4435
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $8.21 | $9.31 | $8.21 | $6.98 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $8.30 | — |
| AL | — | $8.21 | — |
| AR | — | $8.21 | — |
| AZ | — | $8.21 | — |
| CA | — | $8.21 | — |
| CO | — | $8.21 | — |
| CT | — | $8.21 | — |
| DC | — | $8.21 | — |
| DE | — | $8.21 | — |
| FL | — | $8.21 | — |
| GA | — | $8.21 | — |
| HI | — | $8.73 | — |
| IA | — | $8.21 | — |
| ID | — | $8.21 | — |
| IL | — | $8.21 | — |
| IN | — | $8.21 | — |
| KS | — | $8.21 | — |
| KY | — | $8.21 | — |
| LA | — | $8.21 | — |
| MA | — | $8.21 | — |
| MD | — | $8.21 | — |
| ME | — | $8.21 | — |
| MI | — | $8.21 | — |
| MN | — | $8.21 | — |
| MO | — | $8.21 | — |
| MS | — | $8.21 | — |
| MT | — | $8.21 | — |
| NC | — | $8.21 | — |
| ND | — | $8.21 | — |
| NE | — | $8.21 | — |
| NH | — | $8.21 | — |
| NJ | — | $8.21 | — |
| NM | — | $8.21 | — |
| NV | — | $8.21 | — |
| NY | — | $8.21 | — |
| OH | — | $8.21 | — |
| OK | — | $8.21 | — |
| OR | — | $8.21 | — |
| PA | — | $8.21 | — |
| PR | — | $9.31 | — |
| RI | — | $8.21 | — |
| SC | — | $8.21 | — |
| SD | — | $8.21 | — |
| TN | — | $8.21 | — |
| TX | — | $8.21 | — |
| UT | — | $8.21 | — |
| VA | — | $8.21 | — |
| VI | — | $8.21 | — |
| VT | — | $8.21 | — |
| WA | — | $8.21 | — |
| WI | — | $8.21 | — |
| WV | — | $8.21 | — |
| WY | — | $8.21 | — |
How the A4435 fee compares
| Measure | Value |
|---|---|
| Rank among 42 A44 codes (lowest = 1) | 27 |
| Family fee range (average of state fees) | $0.15–$160.42 |
| Rural fee uplift | — |
Who bills A4435 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 43 |
| Referring clinicians | 110 |
| Medicare beneficiaries | 116 |
| States with claims | 13 |
| Share of services in top 3 states (Illinois, Michigan, Missouri) | 34% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 25 | 50 |
| 2023 | 37 | 63 |
| 2024 | 43 | 116 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4435, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 3,162 | 50 | $7.02 | $5.44 |
| 2023 | 3,547 | 63 | $7.52 | $5.73 |
| 2024 | 6,359 | 116 | $7.84 | $6.13 |
States with the most A4435 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Illinois | 600 | $6.16 |
| Michigan | 491 | $5.98 |
| Missouri | 450 | $6.16 |
| Pennsylvania | 450 | $6.12 |
| Ohio | 438 | $6.16 |
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 A4435
- 2026-01-01: Average state fee rose 2.0%: $8.08 to $8.24
- 2013-01-01: A4435 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 A4435?
A4435 is the HCPCS Level II code for ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each. Short descriptor: "1pc ost pch drain hgh output".
How much does Medicare pay for A4435?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $8.21–$9.31. Rural fees can be higher.
Does Medicare cover A4435?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for A4435?
Medicare policy articles that cite A4435 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 A4435 change in 2026?
The average non-rural state fee moved from $8.08 in 2025 to $8.24 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4435 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 A4435
- Watch A4435 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4435
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.