A4437 HCPCS code: Irrigation supply; sleeve, disposable, per month
A4437 is the HCPCS Level II code for irrigation supply; sleeve, disposable, 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 32% from 2022 to 2024 (3,152 to 2,153 services). In 2024, 51 suppliers billed Medicare for A4437 (purchases), serving 152 beneficiaries; Michigan, Georgia, Kentucky accounted for 51% of services. Its average fee ranks 39 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 A4437
| 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 A4437 fee compares
| Measure | Value |
|---|---|
| Rank among 42 A44 codes (lowest = 1) | 39 |
| Family fee range (average of state fees) | $0.15–$160.42 |
| Rural fee uplift | — |
Who bills A4437 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 51 |
| Referring clinicians | 163 |
| Medicare beneficiaries | 152 |
| States with claims | 16 |
| Share of services in top 3 states (Michigan, Georgia, Kentucky) | 51% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 68 | 210 |
| 2023 | 69 | 161 |
| 2024 | 51 | 152 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4437, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 3,152 | 210 | $13.42 | $10.28 |
| 2023 | 2,231 | 161 | $14.88 | $11.22 |
| 2024 | 2,153 | 152 | $20.30 | $15.33 |
States with the most A4437 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Michigan | 393 | $6.47 |
| Georgia | 286 | $18.10 |
| Kentucky | 206 | $17.48 |
| Florida | 149 | $17.48 |
| Minnesota | 124 | $20.51 |
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 A4437
- 2026-01-01: Average state fee rose 2.0%: $24.78 to $25.28
- 2022-01-01: A4437 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 A4437?
A4437 is the HCPCS Level II code for irrigation supply; sleeve, disposable, per month. Short descriptor: "Irr supply sleev disp per mo".
How much does Medicare pay for A4437?
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 A4437?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A4437?
Medicare policy articles that cite A4437 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 A4437 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 A4437
- Watch A4437 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4437
Sources: CMS HCPCS Level II release October 2025; 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.