A4378 — Ostomy pouch, drainable, for use on faceplate, rubber, each
HCPCS Level II A-code · short descriptor: “Drainable rubber pch w/o fp”
- 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.
A4378 Medicare fee schedule (April 2026)
Base (no modifier) Ostomy, tracheostomy & urological supplies
Medicare allowable ranges from $43.82 to $48.17 depending on state and rural status.
Former-CBA payment limits: ceiling $43.82 · floor $37.25
| State | Non-rural | Rural |
|---|---|---|
| AK | $44.24 | — |
| AL | $43.82 | — |
| AR | $43.82 | — |
| AZ | $43.82 | — |
| CA | $43.82 | — |
| CO | $43.82 | — |
| CT | $43.82 | — |
| DC | $43.82 | — |
| DE | $43.82 | — |
| FL | $43.82 | — |
| GA | $43.82 | — |
| HI | $47.31 | — |
| IA | $43.82 | — |
| ID | $43.82 | — |
| IL | $43.82 | — |
| IN | $43.82 | — |
| KS | $43.82 | — |
| KY | $43.82 | — |
| LA | $43.82 | — |
| MA | $43.82 | — |
| MD | $43.82 | — |
| ME | $43.82 | — |
| MI | $43.82 | — |
| MN | $43.82 | — |
| MO | $43.82 | — |
| MS | $43.82 | — |
| MT | $43.82 | — |
| NC | $43.82 | — |
| ND | $43.82 | — |
| NE | $43.82 | — |
| NH | $43.82 | — |
| NJ | $43.82 | — |
| NM | $43.82 | — |
| NV | $43.82 | — |
| NY | $43.82 | — |
| OH | $43.82 | — |
| OK | $43.82 | — |
| OR | $43.82 | — |
| PA | $43.82 | — |
| PR | $48.17 | — |
| RI | $43.82 | — |
| SC | $43.82 | — |
| SD | $43.82 | — |
| TN | $43.82 | — |
| TX | $43.82 | — |
| UT | $43.82 | — |
| VA | $43.82 | — |
| VI | $43.82 | — |
| VT | $43.82 | — |
| WA | $43.82 | — |
| WI | $43.82 | — |
| WV | $43.82 | — |
| WY | $43.82 | — |
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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