A4436 HCPCS code: Irrigation supply; sleeve, reusable, per month
A4436 is the HCPCS Level II code for irrigation supply; sleeve, reusable, per month. The 2026 Medicare DMEPOS fee schedule pays $9.77 to $44.00 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. Medicare volume fell 24% from 2022 to 2024 (9,468 to 7,240 services). In 2024, 150 suppliers billed Medicare for A4436 (purchases), serving 816 beneficiaries; Kentucky, Minnesota, Florida accounted for 25% of services. Its average fee ranks 40 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 | D — Special coverage instructions apply |
| Pricing indicator | 37 — DMEPOS: ostomy, tracheostomy and urological supplies |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 2022-01-01 |
| Last action effective | 2022-01-01 |
2026 Medicare DMEPOS fee schedule for A4436
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $9.77 | $44.00 | $27.33 | $23.23 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $9.77 | — |
| AL | — | $27.33 | — |
| AR | — | $27.33 | — |
| AZ | — | $23.23 | — |
| CA | — | $23.23 | — |
| CO | — | $27.33 | — |
| CT | — | $23.23 | — |
| DC | — | $27.33 | — |
| DE | — | $27.33 | — |
| FL | — | $23.48 | — |
| GA | — | $25.12 | — |
| HI | — | $10.47 | — |
| IA | — | $26.21 | — |
| ID | — | $27.33 | — |
| IL | — | $27.33 | — |
| IN | — | $23.99 | — |
| KS | — | $27.33 | — |
| KY | — | $23.23 | — |
| LA | — | $27.33 | — |
| MA | — | $23.23 | — |
| MD | — | $27.33 | — |
| ME | — | $23.23 | — |
| MI | — | $27.33 | — |
| MN | — | $27.33 | — |
| MO | — | $27.33 | — |
| MS | — | $24.89 | — |
| MT | — | $27.33 | — |
| NC | — | $23.23 | — |
| ND | — | $27.33 | — |
| NE | — | $27.33 | — |
| NH | — | $23.23 | — |
| NJ | — | $27.33 | — |
| NM | — | $23.23 | — |
| NV | — | $23.23 | — |
| NY | — | $24.14 | — |
| OH | — | $27.33 | — |
| OK | — | $23.23 | — |
| OR | — | $23.23 | — |
| PA | — | $27.33 | — |
| PR | — | $44.00 | — |
| RI | — | $23.60 | — |
| SC | — | $25.16 | — |
| SD | — | $27.33 | — |
| TN | — | $23.23 | — |
| TX | — | $27.33 | — |
| UT | — | $23.23 | — |
| VA | — | $23.23 | — |
| VI | — | $24.14 | — |
| VT | — | $23.23 | — |
| WA | — | $27.33 | — |
| WI | — | $27.33 | — |
| WV | — | $27.33 | — |
| WY | — | $27.33 | — |
How the A4436 fee compares
| Measure | Value |
|---|---|
| Rank among 42 A44 codes (lowest = 1) | 40 |
| Family fee range (average of state fees) | $0.15–$160.42 |
| Rural fee uplift | — |
Who bills A4436 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 150 |
| Referring clinicians | 862 |
| Medicare beneficiaries | 816 |
| States with claims | 41 |
| Share of services in top 3 states (Kentucky, Minnesota, Florida) | 25% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 145 | 952 |
| 2023 | 153 | 896 |
| 2024 | 150 | 816 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4436, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 9,468 | 952 | $15.52 | $11.67 |
| 2023 | 8,702 | 896 | $17.62 | $12.67 |
| 2024 | 7,240 | 816 | $18.33 | $13.35 |
States with the most A4436 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Kentucky | 644 | $8.12 |
| Minnesota | 589 | $14.72 |
| Florida | 538 | $12.75 |
| Texas | 459 | $15.76 |
| North Carolina | 452 | $10.10 |
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 A4436
- 2026-01-01: Average state fee rose 2.0%: $24.78 to $25.28
- 2022-01-01: A4436 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 A4436?
A4436 is the HCPCS Level II code for irrigation supply; sleeve, reusable, per month. Short descriptor: "Irr supply sleev reus per mo".
How much does Medicare pay for A4436?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $9.77–$44.00. Rural fees can be higher.
Does Medicare cover A4436?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A4436?
Medicare policy articles that cite A4436 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 A4436 change in 2026?
The average non-rural state fee moved from $24.78 in 2025 to $25.28 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
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 A4436
- Watch A4436 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4436
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.