MyMedi-AI

A4328 — Female external urinary collection device; pouch, each

HCPCS Level II A-code · short descriptor: “Fem urinary collect pouch”

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
Face-to-face & WOPD
Not on the required list
MUE unit limit
93
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

A4328 Medicare fee schedule (October 2026)

Base (no modifier) Ostomy, tracheostomy & urological supplies

Medicare allowable ranges from $12.64 to $16.58 depending on state and rural status.

Former-CBA payment limits: ceiling $14.87 · floor $12.64

StateNon-ruralRural
AK$15.48—
AL$14.87—
AR$14.42—
AZ$14.87—
CA$14.87—
CO$14.87—
CT$12.64—
DC$14.87—
DE$14.87—
FL$14.06—
GA$14.59—
HI$16.58—
IA$14.87—
ID$14.08—
IL$14.87—
IN$14.87—
KS$13.90—
KY$14.75—
LA$14.42—
MA$12.64—
MD$14.87—
ME$12.64—
MI$14.83—
MN$14.42—
MO$14.87—
MS$14.87—
MT$14.87—
NC$14.62—
ND$14.87—
NE$13.90—
NH$12.64—
NJ$14.87—
NM$14.87—
NV$14.87—
NY$14.87—
OH$13.50—
OK$14.87—
OR$14.08—
PA$14.87—
PR$15.42—
RI$14.06—
SC$14.75—
SD$14.87—
TN$14.04—
TX$12.64—
UT$14.87—
VA$14.06—
VI$14.87—
VT$12.64—
WA$14.87—
WI$14.87—
WV$14.42—
WY$14.87—
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). 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.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps A4328 at 93 units per date of service (clinical). Units above the MUE deny — typically as CO-151. Rationale: Published Contractor Policy.

Common denial codes to watch

Related A-codes

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