A4315 — Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone
HCPCS Level II A-code · short descriptor: “Cath w/drainage 2-way silcne”
- Code system
- HCPCS Level II
- Family
- A — Medical & surgical supplies, ambulance
- Medicare coverage status
- Special coverage instructions apply
- DMEPOS payment category
- Ostomy, tracheostomy & urological supplies
- Prior authorization
- Not on Medicare required-PA list
- Status
- Active (April 2026 HCPCS)
Prior authorization
Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
A4315 Medicare fee schedule (April 2026)
Base (no modifier) Ostomy, tracheostomy & urological supplies
Medicare allowable ranges from $31.95 to $48.37 depending on state and rural status.
Former-CBA payment limits: ceiling $37.59 · floor $31.95
| State | Non-rural | Rural |
|---|---|---|
| AK | $45.23 | — |
| AL | $31.95 | — |
| AR | $36.10 | — |
| AZ | $37.59 | — |
| CA | $37.59 | — |
| CO | $37.59 | — |
| CT | $31.95 | — |
| DC | $36.78 | — |
| DE | $36.78 | — |
| FL | $31.95 | — |
| GA | $31.95 | — |
| HI | $48.37 | — |
| IA | $37.59 | — |
| ID | $31.95 | — |
| IL | $37.59 | — |
| IN | $37.59 | — |
| KS | $37.59 | — |
| KY | $37.59 | — |
| LA | $36.03 | — |
| MA | $31.95 | — |
| MD | $31.95 | — |
| ME | $31.95 | — |
| MI | $37.59 | — |
| MN | $37.59 | — |
| MO | $37.59 | — |
| MS | $37.59 | — |
| MT | $32.82 | — |
| NC | $37.59 | — |
| ND | $37.59 | — |
| NE | $37.59 | — |
| NH | $31.95 | — |
| NJ | $36.78 | — |
| NM | $33.51 | — |
| NV | $37.59 | — |
| NY | $37.59 | — |
| OH | $37.59 | — |
| OK | $34.91 | — |
| OR | $31.95 | — |
| PA | $36.78 | — |
| PR | $36.59 | — |
| RI | $31.95 | — |
| SC | $37.59 | — |
| SD | $37.59 | — |
| TN | $37.59 | — |
| TX | $36.65 | — |
| UT | $37.59 | — |
| VA | $31.95 | — |
| VI | $37.59 | — |
| VT | $31.95 | — |
| WA | $37.59 | — |
| WI | $37.59 | — |
| WV | $37.59 | — |
| WY | $37.04 | — |
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026.
Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%.
A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area
adjustments and non-continental rates can differ — verify with your DME MAC.
Common denial codes to watch
Related A-codes
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