A4379 — Ostomy pouch, urinary, with faceplate attached, plastic, each
HCPCS Level II A-code · short descriptor: “Urinary plastic pouch w fcpl”
- 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.
A4379 Medicare fee schedule (April 2026)
Base (no modifier) Ostomy, tracheostomy & urological supplies
Medicare allowable ranges from $21.40 to $23.55 depending on state and rural status.
Former-CBA payment limits: ceiling $21.40 · floor $18.19
| State | Non-rural | Rural |
|---|---|---|
| AK | $21.63 | — |
| AL | $21.40 | — |
| AR | $21.40 | — |
| AZ | $21.40 | — |
| CA | $21.40 | — |
| CO | $21.40 | — |
| CT | $21.40 | — |
| DC | $21.40 | — |
| DE | $21.40 | — |
| FL | $21.40 | — |
| GA | $21.40 | — |
| HI | $23.14 | — |
| IA | $21.40 | — |
| ID | $21.40 | — |
| IL | $21.40 | — |
| IN | $21.40 | — |
| KS | $21.40 | — |
| KY | $21.40 | — |
| LA | $21.40 | — |
| MA | $21.40 | — |
| MD | $21.40 | — |
| ME | $21.40 | — |
| MI | $21.40 | — |
| MN | $21.40 | — |
| MO | $21.40 | — |
| MS | $21.40 | — |
| MT | $21.40 | — |
| NC | $21.40 | — |
| ND | $21.40 | — |
| NE | $21.40 | — |
| NH | $21.40 | — |
| NJ | $21.40 | — |
| NM | $21.40 | — |
| NV | $21.40 | — |
| NY | $21.40 | — |
| OH | $21.40 | — |
| OK | $21.40 | — |
| OR | $21.40 | — |
| PA | $21.40 | — |
| PR | $23.55 | — |
| RI | $21.40 | — |
| SC | $21.40 | — |
| SD | $21.40 | — |
| TN | $21.40 | — |
| TX | $21.40 | — |
| UT | $21.40 | — |
| VA | $21.40 | — |
| VI | $21.40 | — |
| VT | $21.40 | — |
| WA | $21.40 | — |
| WI | $21.40 | — |
| WV | $21.40 | — |
| WY | $21.40 | — |
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
Bill A4379 with confidence
MyMedi-AI scrubs whole claims against NCCI pairs, MUE limits, modifier rules, and PA flags before you submit — built for DME teams, no PHI stored on our servers.
Start free trial Run a CMS-0057-F readiness checkPrefer DIY compliance? Self-audit documentation kits for DME suppliers →