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See a sample rate comparisonHCPCS A4375 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Ostomy pouch, drainable, with faceplate attached, plastic, each
| Key Fact | Detail |
|---|---|
| Service Type | Medical And Surgical Supplies Ostomy Pouches and Supplies |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for A4375 |
National average reimbursement for HCPCS A4375 by major payers:
$20.09
$12.69
$16.12
$28.76
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HCPCS A4375
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$43.89Published rateUjuka Iloabuchi
$18.06Published rateUjuka Iloabuchi
$11.97Published rateBrooks County Hospital
$11.17Published rateKristina Jimenez
Miguel A Arenas Md PC
$6.78Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS A4375 vs. Other Ostomy Pouches and Supplies Codes
The HCPCS A4375 code is part of the Medical And Surgical Supplies services used for Ostomy Pouches and Supplies. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS A4375 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| A4373-HCPCS | Low | Ostomy skin barrier, with flange (solid, flexible or accordian), with built-in convexity, any size, each |
| A4375-HCPCS | Low | Ostomy pouch, drainable, with faceplate attached, plastic, each |
| A4376-HCPCS | Low | Ostomy pouch, drainable, with faceplate attached, rubber, each |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS A4375. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the A4375 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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