# HCPCS A4375: Ostomy pouch, drainable, with faceplate attached, plastic, each

Medicare HCPCS A4375 pays $24.56 on average under the 2026 Q4 Medicare DMEPOS Fee Schedule (non-rural). State amounts run from $24.47 in Wyoming to $26.91 in Puerto Rico, a 10% spread.

Web page: https://www.med-reveal.com/rates/A4375-hcpcs-fee-schedule
Section: DME, Prosthetics, Orthotics and Supplies

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $24.56 |
| National facility | $24.56 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Puerto Rico | $26.91 | $26.91 |
| Hawaii | $26.42 | $26.42 |
| Alaska | $24.68 | $24.68 |
| Alabama | $24.47 | $24.47 |
| Arizona | $24.47 | $24.47 |
| Arkansas | $24.47 | $24.47 |
| California | $24.47 | $24.47 |
| Colorado | $24.47 | $24.47 |
| Connecticut | $24.47 | $24.47 |
| Delaware | $24.47 | $24.47 |
| District of Columbia | $24.47 | $24.47 |
| Florida | $24.47 | $24.47 |
| Georgia | $24.47 | $24.47 |
| Idaho | $24.47 | $24.47 |
| Illinois | $24.47 | $24.47 |
| Indiana | $24.47 | $24.47 |
| Iowa | $24.47 | $24.47 |
| Kansas | $24.47 | $24.47 |
| Kentucky | $24.47 | $24.47 |
| Louisiana | $24.47 | $24.47 |
| Maine | $24.47 | $24.47 |
| Maryland | $24.47 | $24.47 |
| Massachusetts | $24.47 | $24.47 |
| Michigan | $24.47 | $24.47 |
| Minnesota | $24.47 | $24.47 |
| Mississippi | $24.47 | $24.47 |
| Missouri | $24.47 | $24.47 |
| Montana | $24.47 | $24.47 |
| Nebraska | $24.47 | $24.47 |
| Nevada | $24.47 | $24.47 |
| New Hampshire | $24.47 | $24.47 |
| New Jersey | $24.47 | $24.47 |
| New Mexico | $24.47 | $24.47 |
| New York | $24.47 | $24.47 |
| North Carolina | $24.47 | $24.47 |
| North Dakota | $24.47 | $24.47 |
| Ohio | $24.47 | $24.47 |
| Oklahoma | $24.47 | $24.47 |
| Oregon | $24.47 | $24.47 |
| Pennsylvania | $24.47 | $24.47 |
| Rhode Island | $24.47 | $24.47 |
| South Carolina | $24.47 | $24.47 |
| South Dakota | $24.47 | $24.47 |
| Tennessee | $24.47 | $24.47 |
| Texas | $24.47 | $24.47 |
| Utah | $24.47 | $24.47 |
| Vermont | $24.47 | $24.47 |
| Virgin Islands | $24.47 | $24.47 |
| Virginia | $24.47 | $24.47 |
| Washington | $24.47 | $24.47 |
| West Virginia | $24.47 | $24.47 |
| Wisconsin | $24.47 | $24.47 |
| Wyoming | $24.47 | $24.47 |

## Related codes

- A4361: Ostomy faceplate — https://www.med-reveal.com/rates/A4361-hcpcs-fee-schedule
- A4362: Skin barrier, solid, 4x4 or equivalent, each — https://www.med-reveal.com/rates/A4362-hcpcs-fee-schedule
- A4363: Ostomy clamp, any type, replacement only — https://www.med-reveal.com/rates/A4363-hcpcs-fee-schedule
- A4367: Ostomy belt, each — https://www.med-reveal.com/rates/A4367-hcpcs-fee-schedule
- A4371: Ostomy skin barrier, powder, per oz — https://www.med-reveal.com/rates/A4371-hcpcs-fee-schedule
- A4383: Ostomy pouch, drainable, for use on barrier with flange, rubber, each — https://www.med-reveal.com/rates/A4383-hcpcs-fee-schedule
- A4396: Ostomy belt with peristomal hernia support — https://www.med-reveal.com/rates/A4396-hcpcs-fee-schedule
- A4397: Irrigation supply, sleeve, each — https://www.med-reveal.com/rates/A4397-hcpcs-fee-schedule

Commercial negotiated rates for A4375 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules