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HCPCS A4377 Fee Schedule

Last Verified: November 2025

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, for use on faceplate, plastic, each
Key FactDetail
Service Type

Medical And Surgical Supplies

Ostomy Pouches and Supplies

Complexity LevelLow

National average reimbursement for HCPCS A4377 by major payers:

bcbs

$5.02

uhc

$3.17

aetna

$4.14

cigna

$7.14

Preview provider-level rates for...
For billing codeHCPCS A4377
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for HCPCS A4377

United
A4377$10.961073502985 - CHU CHEN42484572 - (MA) MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.MAPediatrics Physician (208000000X)
United
A4377$2.781245248624 - HOSPITAL AUTHORITY OF BEN HILL, DORMINY MEDICAL CENTER581157005GARural Acute Care Hospital (282NR1301X)
United
A4377$10.961073502985 - CHU CHEN42484572MAPediatrics Physician (208000000X)
United
A4377$5.841073502985 - CHU CHEN42484572MAPediatrics Physician (208000000X)
United
A4377$1.911134259328 - BORBAS SURGICAL SUPPLY, INC113568895 - (NY) BORBAS SURGICAL SUPPLY INCNYDurable Medical Equipment & Medical Supplies (332B00000X)
United
A4377$2.781790715381 - NORTHSIDE HOSPITAL, INC., NORTHSIDE HOSPITAL DULUTH582002413GAGeneral Acute Care Hospital (282N00000X)
United
A4377$1.911134259328 - BORBAS SURGICAL SUPPLY, INC113568895 - (NY) BORBAS SURGICAL SUPPLY INCNYDurable Medical Equipment & Medical Supplies (332B00000X)
United
A4377$1.911134259328 - BORBAS SURGICAL SUPPLY, INC113568895 - (NY) BORBAS SURGICAL SUPPLY INCNYDurable Medical Equipment & Medical Supplies (332B00000X)
United
A4377$4.051720098791 - IRWIN COUNTY HOSPITAL586003765GAGeneral Acute Care Hospital (282N00000X)
United
A4377$1.991235153883 - WILDWOOD SANITARIUM, INCORPORATED, WILDWOOD LIFESTYLE CENTER AND HOSPITAL586039864 - (GA) WILDWOOD SANITARIUM INCORPORATEDGAGeneral Acute Care Hospital (282N00000X)
United
A4377$2.781316938459 - NAVICENT HEALTH OCONEE, LLC, NAVICENT HEALTH BALDWIN582359398 - NAVICENT HEALTH OCONEE LLCGAGeneral Acute Care Hospital (282N00000X)
United
A4377$2.531881144889 - NGMC BARROW LLC, NGMC BARROW581177261 - (GA) GAINESVILLE RADIOLOGY GROUPGAGeneral Acute Care Hospital (282N00000X)
United
A4377$6.921255401519 - THE MEDICAL CENTER INC, PIEDMONT COLUMBUS REGIONAL MIDTOWN581685139 - (GA) THE MEDICAL CENTER INCGAGeneral Acute Care Hospital (282N00000X)
United
A4377$2.991972731800 - MERIWETHER HEALTHCARE, L.L.C., WARM SPRINGS MEDICAL CENTER870764535 - (GA) MERIWETHER HEALTHCARE, LLC D/B/A WARM SPRINGS MEDICAL CENTERGACritical Access Hospital (282NC0060X)
United
A4377$5.031992789721 - PHOEBE PUTNEY MEMORIAL HOSPITAL INC, PHOEBE PUTNEY MEMORIAL HOSPTIAL263792403 - PHOEBE PHYSICIAN GROUP INCGAGeneral Acute Care Hospital (282N00000X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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HCPCS A4377 vs. Other Ostomy Pouches and Supplies Codes

The HCPCS A4377 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 A4377 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.

CodeComplexityDescription
A4376-HCPCSLowOstomy pouch, drainable, with faceplate attached, rubber, each
A4377-HCPCSLowOstomy pouch, drainable, for use on faceplate, plastic, each
A4378-HCPCSLowOstomy pouch, drainable, for use on faceplate, 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 A4377. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the A4377 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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