A4380 — Ostomy pouch, urinary, with faceplate attached, rubber, each
HCPCS Level II A-code · short descriptor: “Urinary rubber pouch w fcplt”
- 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.
A4380 Medicare fee schedule (April 2026)
Base (no modifier) Ostomy, tracheostomy & urological supplies
Medicare allowable ranges from $53.20 to $58.50 depending on state and rural status.
Former-CBA payment limits: ceiling $53.20 · floor $45.22
| State | Non-rural | Rural |
|---|---|---|
| AK | $53.70 | — |
| AL | $53.20 | — |
| AR | $53.20 | — |
| AZ | $53.20 | — |
| CA | $53.20 | — |
| CO | $53.20 | — |
| CT | $53.20 | — |
| DC | $53.20 | — |
| DE | $53.20 | — |
| FL | $53.20 | — |
| GA | $53.20 | — |
| HI | $57.44 | — |
| IA | $53.20 | — |
| ID | $53.20 | — |
| IL | $53.20 | — |
| IN | $53.20 | — |
| KS | $53.20 | — |
| KY | $53.20 | — |
| LA | $53.20 | — |
| MA | $53.20 | — |
| MD | $53.20 | — |
| ME | $53.20 | — |
| MI | $53.20 | — |
| MN | $53.20 | — |
| MO | $53.20 | — |
| MS | $53.20 | — |
| MT | $53.20 | — |
| NC | $53.20 | — |
| ND | $53.20 | — |
| NE | $53.20 | — |
| NH | $53.20 | — |
| NJ | $53.20 | — |
| NM | $53.20 | — |
| NV | $53.20 | — |
| NY | $53.20 | — |
| OH | $53.20 | — |
| OK | $53.20 | — |
| OR | $53.20 | — |
| PA | $53.20 | — |
| PR | $58.50 | — |
| RI | $53.20 | — |
| SC | $53.20 | — |
| SD | $53.20 | — |
| TN | $53.20 | — |
| TX | $53.20 | — |
| UT | $53.20 | — |
| VA | $53.20 | — |
| VI | $53.20 | — |
| VT | $53.20 | — |
| WA | $53.20 | — |
| WI | $53.20 | — |
| WV | $53.20 | — |
| WY | $53.20 | — |
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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