{"id":180319,"date":"2026-08-17T07:15:19","date_gmt":"2026-08-17T07:15:19","guid":{"rendered":"https:\/\/pabau.com\/?p=180319"},"modified":"2026-08-18T13:17:57","modified_gmt":"2026-08-18T13:17:57","slug":"hcpcs-code-a4426","status":"publish","type":"post","link":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4426\/","title":{"rendered":"HCPCS code A4426: Ostomy pouch billing and fee schedule"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"HCPCS code A4426: Ostomy pouch billing, Medicare, and fee schedule\",\"description\":\"HCPCS code A4426 (ostomy pouch, drainable; for use on barrier with locking flange, 2 piece system, each) billing reference covering the unit of service, Medicare coverage under LCD L33828, fee schedule, ICD-10 pairing, and related codes.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4426\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-07\",\"dateModified\":\"2026-08-17\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>HCPCS code A4426 covers a drainable ostomy pouch made for a barrier with a locking flange in a 2-piece system.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The unit of service is each. In other words, one billed unit equals one pouch, and the code carries no per-10 package quantity.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Medicare Part B covers A4426 as a DMEPOS supply under the Ostomy Supplies LCD (L33828) when a physician order supports it.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The DME MAC quantity guideline for drainable pouches is 20 per month, which reaches the claim as 20 units of A4426.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>A4427 is the same pouch with a filter added. In other words, flange type does not separate the two codes, and both are billed each.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau keeps the physician order, the dispensed quantity, and the diagnosis codes on one record.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">HCPCS code A4426 describes a drainable ostomy pouch made for a barrier with a locking flange in a 2-piece system. Its unit of service is each, so 20 pouches means 20 units on the claim.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Billers who treat the code as a box of 10, for instance, understate every claim they send. In short, two details decide whether an A4426 claim pays: first, the exact product configuration, and second, the unit count.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This reference covers the official descriptor, the unit of service, and Medicare fee schedule context. It also covers LCD coverage criteria, ICD-10 pairing, documentation, and the adjacent A4421 to A4437 codes.<\/p>\n\n\n\n<h2 id=\"h-hcpcs-code-a4426-official-descriptor-and-code-details\" class=\"wp-block-heading\">HCPCS code A4426: official descriptor and code details<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/healthcare-common-procedure-system\" target=\"_blank\" rel=\"nofollow noopener\">Centers for Medicare and Medicaid Services (CMS)<\/a> maintains the HCPCS Level II code set. Accordingly, A4426 carries the following official descriptor and code details.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">HCPCS code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A4426<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official long descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Short descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ost pch drain 2 piece system<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code system<\/td>\n<td style=\"padding:12px 16px;color:#374151\">HCPCS Level II (A-series supply codes)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Benefit category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Unit of service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each. That is, one billed unit equals one pouch<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Primary payer<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medicare Part B, submitted to the DME MAC<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Governing policy<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ostomy Supplies LCD L33828 and Policy Article A52487<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active. Therefore, verify against the current CMS HCPCS Level II quarterly file<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The A-series (A0000 to A9999) holds the HCPCS Level II transport, medical, and surgical supply codes. Specifically, A4426 sits inside the A4421 to A4437 ostomy cluster, and three attributes fix its identity. First, the pouch is drainable rather than closed; second, it fits a locking-flange barrier rather than a non-locking one; and finally, it has no filter.<\/p>\n\n\n\n<h2 id=\"h-what-hcpcs-code-a4426-covers\" class=\"wp-block-heading\">What HCPCS code A4426 covers<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A4426 covers the pouch component only, not the barrier wafer, of a 2-piece drainable system. Because the pouch locks onto a separately coded barrier, the patient can change pouches without lifting the skin barrier off the skin. In contrast, one-piece systems, where the pouch and barrier are joined, carry different codes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The code applies to fecal-output ostomies:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Colostomy:<\/strong> surgical diversion of the colon through the abdominal wall, often after bowel resection or colorectal cancer surgery<\/li>\n\n\n\n<li><strong>Ileostomy:<\/strong> surgical diversion of the ileum, commonly for Crohn&rsquo;s disease, ulcerative colitis, or familial polyposis<\/li>\n\n\n\n<li><strong>Other gastrointestinal diversions:<\/strong> stomas documented under Z93.4, where the patient wears a drainable pouch on a locking-flange barrier<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Supply orders for those patients come from a few settings. Typically, post-surgical follow-up sets the supply up, and <a href=\"https:\/\/pabau.com\/industry\/gp-clinic-software\/\">primary care<\/a> then handles the renewals. In addition, some come from the <a href=\"https:\/\/pabau.com\/industry\/functional-medicine-software\/\">functional medicine<\/a> practices treating the underlying bowel disease.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Urinary diversions, however, do not use A4426. Instead, a urostomy pouch needs a faucet-type tap with a valve, and codes <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4428\/\">A4428<\/a> through A4434 describe those products. Therefore, sending a urostomy claim on A4426 is a product mismatch, even though both pouch types drain.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The drainable classification means the pouch has an openable outlet at the bottom, so the patient empties it without taking the pouch off. By contrast, closed pouches, which carry their own codes, are discarded after each use. As a result, drainable pouches suit higher-output stomas, where frequent full changes would be impractical.<\/p>\n\n\n\n<h2 id=\"h-the-unit-of-service-for-a4426-one-unit-one-pouch\" class=\"wp-block-heading\">The unit of service for A4426: one unit, one pouch<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">In other words, one unit of A4426 equals one pouch. That is because the CMS long descriptor ends in the word each, and the code carries no package multiplier.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This is worth stating plainly, because several third-party billing summaries still describe 2-piece pouch codes as per 10. However, that convention does not apply here. Instead, a prescription for 20 drainable pouches is submitted as 20 units of A4426, not 2 units.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Most A-series supply codes, in fact, are written the same way. For example, <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4490\/\">A4490<\/a> also ends in each, so its unit count matches the number of items dispensed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Getting this backwards under-bills the claim by a factor of ten. It also puts the unit count out of step with the proof of delivery, and that pairing is the first thing a post-payment reviewer compares. Consequently, suppliers who reconcile the two figures before submission rarely see a quantity denial.<\/p>\n\n\n\n<h2 id=\"h-a4426-medicare-fee-schedule-and-reimbursement-rates\" class=\"wp-block-heading\">A4426 Medicare fee schedule and reimbursement rates<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare pays A4426 from the DMEPOS fee schedule, not the Physician Fee Schedule. Therefore, look the allowance up in the CMS DMEPOS fee schedule file rather than a physician pricing tool, which does not price supply codes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The payment framework for A4426 works like this:<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Fee schedule element<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Paying schedule<\/td>\n<td style=\"padding:12px 16px;color:#374151\">DMEPOS fee schedule, published and updated by CMS<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Rate basis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A flat allowance for each pouch, since the code is billed each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Rate variation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">State-level allowances, with separate rural and non-rural columns<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicare payment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">80% of the allowed amount, with 20% patient coinsurance after the deductible<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Update cycle<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CMS revises the DMEPOS file quarterly, with the annual update effective January 1<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Where to look<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The DMEPOS fee schedule public use file, downloaded from CMS.gov<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">State Medicaid programs publish their own flat per-unit rate for ostomy pouches, usually with a monthly unit cap that matches the Medicare guideline of 20. Even so, those rates are set per unit, so the same one-pouch-per-unit logic applies. Therefore, check the applicable state fee file before you quote a figure.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Because allowances change quarterly and vary by state, treat any hardcoded dollar amount in a reference resource as illustrative. In other words, only the current CMS file settles the rate. Wider <a href=\"https:\/\/pabau.com\/blog\/medicare-billing\/\">Medicare billing<\/a> rules then set the coinsurance and the deductible order.<\/p>\n\n\n\n<h2 id=\"h-when-medicare-covers-a4426-lcd-l33828\" class=\"wp-block-heading\">When Medicare covers A4426: LCD L33828<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare Part B covers A4426 under the DMEPOS benefit when the patient has a surgically created ostomy and a valid physician order. The rules sit in the <a href=\"https:\/\/www.cms.gov\/medicare-coverage-database\/view\/lcd.aspx?lcdid=33828\" target=\"_blank\" rel=\"nofollow noopener\">Ostomy Supplies LCD (L33828)<\/a> and its <a href=\"https:\/\/www.cms.gov\/medicare-coverage-database\/view\/article.aspx?articleid=52487\" target=\"_blank\" rel=\"nofollow noopener\">Policy Article A52487<\/a>, applied by the DME MACs.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Core coverage requirements include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>A confirmed ostomy:<\/strong> the record must show a surgical colostomy or ileostomy, and the claim must carry the matching diagnosis code<\/li>\n\n\n\n<li><strong>A physician order:<\/strong> the treating practitioner signs a written order naming the item and the quantity before the supplier bills<\/li>\n\n\n\n<li><strong>Medical necessity in the file:<\/strong> ongoing need is usually established at surgery and carried forward, but it has to be produceable on request<\/li>\n\n\n\n<li><strong>An enrolled supplier:<\/strong> the DMEPOS supplier must be Medicare-enrolled and accredited to bill ostomy supplies<\/li>\n\n\n\n<li><strong>Quantities inside the guideline:<\/strong> the LCD sets a routine monthly allowance, and going above it without documentation triggers a coverage edit<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The LCD guideline for drainable pouches is up to 20 per month. Because A4426 is billed each, the routine maximum on a monthly claim is 20 units. However, larger quantities are payable, but the medical record has to explain why this patient needs more. For reference, Noridian and CGS both publish maximum-quantity tables for every ostomy code in their jurisdictions.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Check the patient&rsquo;s Medicare enrollment before you bill. If the patient has a Medicare Advantage plan rather than Original Medicare Part B, the claim goes to the plan administrator. In that case, the DME MAC does not process it, and the plan&rsquo;s quantity caps can differ from the L33828 guideline.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-documentation-requirements-for-billing-a4426\" class=\"wp-block-heading\">Documentation requirements for billing A4426<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A paid A4426 claim rests on four documents the supplier has to be able to produce on request:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Standard written order:<\/strong> patient name, order date, the item description or HCPCS code, the quantity, and the treating practitioner&rsquo;s signature<\/li>\n\n\n\n<li><strong>Proof of the ostomy:<\/strong> an operative report, discharge summary, or clinical note establishing the colostomy or ileostomy<\/li>\n\n\n\n<li><strong>Proof of delivery:<\/strong> a dispensing record showing the date and the number of pouches actually supplied<\/li>\n\n\n\n<li><strong>Refill documentation:<\/strong> evidence that the patient still needs and is still using the supply, dated before each new shipment<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The quantity on the proof of delivery has to match the unit count on the claim. In other words, twenty pouches delivered means 20 units billed, with no conversion step in between. As a result, a mismatch between those two numbers is the easiest recoupment a reviewer can write up.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Those four documents also have to be stored to federal standards. Working through a <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-checklist-for-primary-care\/\">HIPAA compliance checklist<\/a> is a practical way to confirm that.<\/p>\n\n\n\n<h2 id=\"h-icd-10-diagnosis-codes-that-support-the-claim\" class=\"wp-block-heading\">ICD-10 diagnosis codes that support the claim<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">An A4426 claim needs an ICD-10 code that documents the ostomy itself, which is normally a Z93 status code. However, underlying-condition codes support the claim but do not replace the status code. Capturing that detail on <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">digital intake forms<\/a> keeps it on the record from the first visit.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-a4426\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&rsquo;s customizable consent and intake forms capture the ostomy history, lab orders, and patient signature that a supply claim later relies on.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">The codes below are the ones that appear most often on drainable pouch claims. They document medical necessity, but none of them guarantees payment on its own.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10 code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">How it is used<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z93.2<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ileostomy status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Primary status code on ileostomy supply claims<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z93.3<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Colostomy status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Primary status code on colostomy supply claims<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z93.4<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other artificial openings of gastrointestinal tract status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other gastrointestinal diversions using a drainable pouch<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z43.2<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Encounter for attention to ileostomy<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Encounter code for stoma care and pouch management visits<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z43.3<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Encounter for attention to colostomy<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Encounter code for stoma care and pouch management visits<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">C18.9<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Malignant neoplasm of colon, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Supporting diagnosis on colostomy cases<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">C20<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Malignant neoplasm of rectum<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Supporting diagnosis on colostomy cases<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">K50.90<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Crohn&rsquo;s disease, unspecified, without complications<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Supporting diagnosis on ileostomy cases<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">K51.90<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ulcerative colitis, unspecified, without complications<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Supporting diagnosis on ileostomy cases<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">K57.20<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Diverticulitis of large intestine with perforation and abscess without bleeding<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Supporting diagnosis on colostomy cases<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">List the Z93 status code first on a supply claim, then add the underlying condition when the record supports it. Urinary status codes such as Z93.50 and Z93.6 do not belong on an A4426 claim, because A4426 is not a urinary pouch. Noridian and CGS publish the diagnosis codes each LCD accepts.<\/p>\n\n\n\n<h2 id=\"h-how-to-bill-hcpcs-code-a4426-step-by-step\" class=\"wp-block-heading\">How to bill HCPCS code A4426: step by step<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Four elements decide whether an A4426 claim pays. Specifically, they are the code, the unit count, the modifier, and the supporting diagnosis. In turn, <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">Claims management software<\/a> that validates all four before submission cuts the denial rate. Meanwhile, <a href=\"https:\/\/pabau.com\/blog\/ehr-integration\/\">EHR integration<\/a> keeps the order and the claim on the same record. Here is the standard workflow.<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>First, <strong>confirm the product:<\/strong> check that the patient uses a 2-piece system with a locking-flange barrier, and that the pouch has no filter. In other words, a filtered pouch on the same barrier is A4427.<\/li>\n\n\n\n<li>Next, <strong>count the pouches:<\/strong> bill one unit for every pouch supplied. In other words, twenty pouches is 20 units, and there is no division by 10 anywhere in this step.<\/li>\n\n\n\n<li>Then, <strong>select the modifier:<\/strong> add KX when the record meets the LCD criteria. Alternatively, use GA when the patient has signed an Advance Beneficiary Notice for an item likely to be denied. Either way, confirm current modifier rules with the DME MAC.<\/li>\n\n\n\n<li>After that, <strong>attach the diagnosis:<\/strong> include the Z93 ostomy status code, plus any underlying condition code the record supports. In every case, the codes on the claim must match the physician order and the chart.<\/li>\n\n\n\n<li>Once that&rsquo;s done, <strong>complete the CMS-1500 or 837P:<\/strong> A4426 and its modifier go in Box 24D. Meanwhile, the unit count goes in Box 24G, and the ICD-10 codes in Box 21.<\/li>\n\n\n\n<li>Finally, <strong>submit to the DME MAC:<\/strong> ostomy supply claims go to the patient&rsquo;s DME MAC rather than the local Part B contractor. That contractor also handles equipment claims such as <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-k0808\/\">K0808<\/a>.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">Keeping thorough <a href=\"https:\/\/pabau.com\/blog\/medical-forms-at-your-healthcare-practice\/\">medical forms<\/a> at every step protects the practice during post-payment review. For this reason, DME MACs run post-payment audits on ostomy supply claims, and suppliers without a complete file face recoupment.<\/p>\n\n\n\n<h2 id=\"h-common-billing-errors-for-drainable-ostomy-pouches\" class=\"wp-block-heading\">Common billing errors for drainable ostomy pouches<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Two error types cluster around A4426. Specifically, one is the unit count, and the other is a product mismatch inside the A4421 to A4437 range. In addition, thin refill and <a href=\"https:\/\/pabau.com\/blog\/patient-compliance\/\">patient compliance<\/a> records make a third. Here are the frequent mistakes and their fixes.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Error type<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">What goes wrong<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">How to fix it<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Unit count treated as per 10<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Billing 2 units for 20 pouches, on the assumption that one unit covers a box of 10<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bill one unit per pouch. The official descriptor ends in each, so 20 pouches is 20 units<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Filter variant mixed up<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Billing A4426 for a filtered pouch on a locking-flange barrier, which is A4427<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Read the product specification for a filter before choosing between A4426 and A4427<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Flange type mixed up<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Billing A4426 for a non-locking flange system, which points to A4425 instead<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Confirm whether the barrier uses a lever-type locking mechanism or a push-on fit<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Urinary pouch on a fecal code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Billing A4426 for a urostomy pouch that has a faucet-type tap with a valve<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use the urinary pouch codes in the A4428 to A4434 range<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Missing KX modifier<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Omitting KX when the record does meet the LCD medical necessity criteria<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Confirm the file satisfies L33828, then attach KX before submission<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Missing diagnosis code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Submitting A4426 with no ICD-10 code, or with an unrelated diagnosis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Always include the Z93 status code, and add the underlying condition when available<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Above-guideline quantity<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Billing more than 20 units in a month with nothing in the record to justify it<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Document the clinical reason for the higher quantity before you submit the claim<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Wrong claim destination<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sending A4426 to the Part B contractor rather than the DME MAC<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Confirm the patient&rsquo;s DME MAC by state and route with the correct payer ID<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/blog\/patient-data-security-tools\/\">Patient data security tools<\/a> keep a complete audit trail for supply orders and physician certifications. In turn, that trail protects the practice when a claim is pulled for review. Indeed, post-payment audits are routine for DMEPOS suppliers, and thin documentation is the most frequent recoupment trigger.<\/p>\n\n\n\n<h2 id=\"h-code-history-and-effective-dates\" class=\"wp-block-heading\">Code history and effective dates<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CMS maintains HCPCS Level II and publishes quarterly updates, with the main annual release taking effect on January 1. A4426 sits in the long-standing A4421 to A4437 ostomy cluster and currently carries the drainable locking-flange descriptor, billed each. Code status history matters for backdated claims and audit defense, so keep a record of the release you billed under.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code detail<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Status and guidance<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Current status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active in the current CMS HCPCS Level II release<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Current unit of service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each. However, third-party summaries that still show per 10 for this code are not current<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Update cycle<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CMS publishes quarterly HCPCS updates, and the annual file takes effect January 1<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Termination date<\/td>\n<td style=\"padding:12px 16px;color:#374151\">None assigned. Therefore, check the current CMS file before billing a future date of service<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">How to verify<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Download the HCPCS Level II quarterly file from CMS.gov, which lists effective and termination dates<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Coding teams should subscribe to CMS update notices and read the annual HCPCS release each fall. Codes in the A4421 to A4437 range do get revised, and a deleted or reworded code produces an immediate rejection. For example, the CGS coding verification resource carries further guidance for DMEPOS products billed through that jurisdiction.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Set a calendar reminder for October each year to review the new CMS HCPCS release. Then, cross-check every ostomy code your practice bills against the updated file before January 1. As a result, a 15-minute review prevents rejected claims from the first week of the new year.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-related-ostomy-supply-hcpcs-codes-a4421-to-a4437\" class=\"wp-block-heading\">Related ostomy supply HCPCS codes: A4421 to A4437<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Three variables pick the right code in this range. Specifically, they are the pouch type, the system type, and the barrier attachment method. In addition, whether the pouch has a filter splits several of the pairs as well. <a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\">Practice management software<\/a> with a built-in HCPCS library cuts selection errors at the point of order. The table below carries the current CMS descriptors.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">HCPCS code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Official descriptor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Unit of service<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4421<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ostomy supply; miscellaneous<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4422<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ostomy absorbent material (sheet\/pad\/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4423<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4424<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4425<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\"><strong>A4426<\/strong><\/td>\n<td style=\"padding:12px 16px;color:#374151\"><strong>Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each<\/strong><\/td>\n<td style=\"padding:12px 16px;color:#374151\"><strong>Each<\/strong><\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4427<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4428<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4429<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4430<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4431<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4432<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4433<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4434<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4435<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4436<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Irrigation supply; sleeve, reusable, per month<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Per month<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4437<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Irrigation supply; sleeve, disposable, per month<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Per month<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A4426 vs A4427:<\/strong> these two are the pair most often confused, and the reason is usually a misreading of the descriptors. <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4427\/\">A4427<\/a> covers the same drainable pouch on the same locking-flange 2-piece barrier, with a filter added. In short, the filter is the only difference. Flange type does not separate them, and both are billed each.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A4426 vs A4425:<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4425\/\">A4425<\/a> is the non-locking flange counterpart, and it carries a filter as well. If the barrier uses a push-on fit rather than a lever-type locking mechanism, A4426 is the wrong code.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A4426 vs A4424:<\/strong> A4424 covers a one-piece drainable pouch with the barrier already attached and a filter included. Consequently, a patient moving from a 2-piece to a 1-piece system needs both a code change and a new physician order.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A4426 vs A4428 and A4429:<\/strong> both of those codes describe urinary pouches, not fecal ones. Each has an attached barrier and a faucet-type tap with a valve, and A4429 adds built-in convexity. Therefore, neither belongs on a colostomy or ileostomy claim.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For a urostomy patient on a locking-flange 2-piece system, the parallel codes are <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4433\/\">A4433<\/a> and A4434. Specifically, A4434 is the version with a faucet-type tap with valve. Reading the tap and the flange together is the fastest way to land on the right code.<\/p>\n\n\n\n<h2 id=\"h-how-pabau-keeps-ostomy-supply-claims-accurate\" class=\"wp-block-heading\">How Pabau keeps ostomy supply claims accurate<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most ostomy claim errors start upstream, in how the supply order is captured and matched to a code. For example, a practice working from paper delivery notes re-keys the pouch count into the claim by hand, and that is where 20 units becomes 2.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau keeps the physician order, the dispensed quantity, the HCPCS code, and the claim status together on one patient record. As a result, the unit count on the claim comes from the dispensing record rather than from memory, so a mismatch shows up before the claim leaves the practice.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-a4426\/automate-claims-through-healthcode.webp\" alt=\"Billing and insurer invoicing in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau closes out the visit and produces an itemized insurer invoice, so the supply quantities you billed match what the patient actually received.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">For suppliers running recurring monthly ostomy orders, the same record keeps refill dates, standing orders, and diagnosis codes linked. A stale order surfaces before it holds up a batch of claims, so a month of shipments bills cleanly the first time.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Reduce DMEPOS claim denials with Pabau                <\/h3>\n\n                <p class=\"description\">\n                    Pabau&rsquo;s claims management software helps billing teams match unit counts to the dispensing record and validate HCPCS codes before submission. See how it works for your practice.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A4426 is a narrow code, and that precision is what makes it error-prone. Specifically, the descriptor fixes three attributes at once: the pouch is drainable, it has no filter, and it fits a locking-flange 2-piece barrier.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The unit of service is the detail worth correcting first. One unit is one pouch, so a routine monthly maximum of 20 pouches bills as 20 units. Therefore, any workflow that divides the pouch count by 10 understates every claim it touches.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau helps DMEPOS billing teams track supply codes and tie unit counts to the dispensing record. It also holds the documentation trail that post-payment review asks for. To see how that shortens claim processing time, <a href=\"https:\/\/pabau.com\/book-demo\/\">book a demo<\/a> with the Pabau team.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing the catch-all ostomy supply code?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4421\/\">HCPCS code A4421<\/a> covers when the miscellaneous code is appropriate and what documentation a DME MAC expects with it.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Dispensing closed pouches instead of drainable ones?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4423\/\">HCPCS code A4423<\/a> is the closed pouch for a locking-flange barrier with a filter.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Wondering whether every supply code is billed each?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4259\/\">HCPCS code A4259<\/a> is billed per box, which is a useful contrast when you set up unit counts.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing another DMEPOS supply on the same rules?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4490\/\">HCPCS code A4490<\/a> shows how the each convention works outside the ostomy range.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding an orthosis rather than a supply?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-l1010\/\">HCPCS code L1010<\/a> walks through DMEPOS orthosis documentation and where the claim goes.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786699099901\"><h3 class=\"schema-faq-question\">What is HCPCS code A4426?<\/h3> <p class=\"schema-faq-answer\">HCPCS code A4426 is a Level II supply code for a drainable ostomy pouch. Specifically, the pouch is made for a barrier with a locking flange in a 2-piece system. The unit of service is each, so one billed unit equals one pouch. Additionally, CMS maintains the code in the HCPCS Level II A-series, and Medicare pays it from the DMEPOS fee schedule.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786699099902\"><h3 class=\"schema-faq-question\">How many pouches does one unit of A4426 cover?<\/h3> <p class=\"schema-faq-answer\">One unit of A4426 covers one pouch. The CMS long descriptor ends in the word each, and the code carries no per-10 package quantity. In other words, a prescription for 20 drainable pouches is billed as 20 units, not 2 units. Therefore, third-party summaries that still describe the code as per 10 are out of date.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786699099903\"><h3 class=\"schema-faq-question\">Is HCPCS code A4426 covered by Medicare?<\/h3> <p class=\"schema-faq-answer\">Yes. Medicare Part B covers A4426 under the DMEPOS benefit when the patient has a documented colostomy or ileostomy and a valid physician order. The claim also has to meet the quantity and documentation rules in the Ostomy Supplies LCD (L33828).<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786699099906\"><h3 class=\"schema-faq-question\">What modifier should be used with HCPCS code A4426?<\/h3> <p class=\"schema-faq-answer\">The KX modifier goes on the claim when the record shows that the LCD L33828 medical necessity criteria are met. Use GA instead when the patient has signed an Advance Beneficiary Notice for an item likely to be denied. Confirm the unit count also sits inside the monthly guideline before adding KX.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786699099907\"><h3 class=\"schema-faq-question\">How many units of A4426 will Medicare pay per month?<\/h3> <p class=\"schema-faq-answer\">The DME MAC guideline for drainable ostomy pouches is up to 20 per month, which is 20 units of A4426. Higher quantities can still be paid, but the medical record has to explain why this patient needs more. For instance, Noridian and CGS publish maximum quantity tables for every ostomy code.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>HCPCS code A4426 describes a drainable ostomy pouch made for a barrier with a locking flange in a 2-piece system. Its unit of service is each, so 20 pouches means 20 units on the claim. Billers who treat the code as a box of 10, for instance, understate every claim they send. In short, two [&hellip;]<\/p>\n","protected":false},"author":84,"featured_media":180318,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"77","_yoast_wpseo_content_score":"90","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1548],"tags":[1364,1582,1609,3044],"class_list":["post-180319","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-hcpcs","tag-billing","tag-hcpcs","tag-medicare-dme","tag-medicare-part-b"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>HCPCS code A4426: Ostomy pouch billing and fee schedule<\/title>\n<meta name=\"description\" content=\"A4426 covers a drainable locking-flange ostomy pouch. 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Outside of work, she enjoys photography, weekend getaways, and finding inspiration in everyday experiences.","url":"https:\/\/pabau.com\/fr\/blog\/author\/despina-petrushevska\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4426\/#faq-question-1786699099901","position":1,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4426\/#faq-question-1786699099901","name":"What is HCPCS code A4426?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"HCPCS code A4426 is a Level II supply code for a drainable ostomy pouch. Specifically, the pouch is made for a barrier with a locking flange in a 2-piece system. The unit of service is each, so one billed unit equals one pouch. Additionally, CMS maintains the code in the HCPCS Level II A-series, and Medicare pays it from the DMEPOS fee schedule.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4426\/#faq-question-1786699099902","position":2,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4426\/#faq-question-1786699099902","name":"How many pouches does one unit of A4426 cover?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"One unit of A4426 covers one pouch. The CMS long descriptor ends in the word each, and the code carries no per-10 package quantity. In other words, a prescription for 20 drainable pouches is billed as 20 units, not 2 units. Therefore, third-party summaries that still describe the code as per 10 are out of date.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4426\/#faq-question-1786699099903","position":3,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4426\/#faq-question-1786699099903","name":"Is HCPCS code A4426 covered by Medicare?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Yes. Medicare Part B covers A4426 under the DMEPOS benefit when the patient has a documented colostomy or ileostomy and a valid physician order. The claim also has to meet the quantity and documentation rules in the Ostomy Supplies LCD (L33828).","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4426\/#faq-question-1786699099906","position":4,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4426\/#faq-question-1786699099906","name":"What modifier should be used with HCPCS code A4426?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The KX modifier goes on the claim when the record shows that the LCD L33828 medical necessity criteria are met. Use GA instead when the patient has signed an Advance Beneficiary Notice for an item likely to be denied. Confirm the unit count also sits inside the monthly guideline before adding KX.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4426\/#faq-question-1786699099907","position":5,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-a4426\/#faq-question-1786699099907","name":"How many units of A4426 will Medicare pay per month?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The DME MAC guideline for drainable ostomy pouches is up to 20 per month, which is 20 units of A4426. Higher quantities can still be paid, but the medical record has to explain why this patient needs more. For instance, Noridian and CGS publish maximum quantity tables for every ostomy code.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"}]}},"yoast":{"focus_keyword":"HCPCS Code A4426","seo_title":"HCPCS code A4426: Ostomy pouch billing and fee schedule","meta_description":"A4426 covers a drainable locking-flange ostomy pouch. 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