A4391 — Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each
HCPCS Level II A-code · short descriptor: “Urinary pouch w ex wear barr”
- 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.
A4391 Medicare fee schedule (April 2026)
Base (no modifier) Ostomy, tracheostomy & urological supplies
Medicare allowable ranges from $10.07 to $11.08 depending on state and rural status.
Former-CBA payment limits: ceiling $10.07 · floor $8.56
| State | Non-rural | Rural |
|---|---|---|
| AK | $10.17 | — |
| AL | $10.07 | — |
| AR | $10.07 | — |
| AZ | $10.07 | — |
| CA | $10.07 | — |
| CO | $10.07 | — |
| CT | $10.07 | — |
| DC | $10.07 | — |
| DE | $10.07 | — |
| FL | $10.07 | — |
| GA | $10.07 | — |
| HI | $10.91 | — |
| IA | $10.07 | — |
| ID | $10.07 | — |
| IL | $10.07 | — |
| IN | $10.07 | — |
| KS | $10.07 | — |
| KY | $10.07 | — |
| LA | $10.07 | — |
| MA | $10.07 | — |
| MD | $10.07 | — |
| ME | $10.07 | — |
| MI | $10.07 | — |
| MN | $10.07 | — |
| MO | $10.07 | — |
| MS | $10.07 | — |
| MT | $10.07 | — |
| NC | $10.07 | — |
| ND | $10.07 | — |
| NE | $10.07 | — |
| NH | $10.07 | — |
| NJ | $10.07 | — |
| NM | $10.07 | — |
| NV | $10.07 | — |
| NY | $10.07 | — |
| OH | $10.07 | — |
| OK | $10.07 | — |
| OR | $10.07 | — |
| PA | $10.07 | — |
| PR | $11.08 | — |
| RI | $10.07 | — |
| SC | $10.07 | — |
| SD | $10.07 | — |
| TN | $10.07 | — |
| TX | $10.07 | — |
| UT | $10.07 | — |
| VA | $10.07 | — |
| VI | $10.07 | — |
| VT | $10.07 | — |
| WA | $10.07 | — |
| WI | $10.07 | — |
| WV | $10.07 | — |
| WY | $10.07 | — |
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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