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HCPCS A4390 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, with extended wear barrier attached, with built-in convexity (1-piece), each
Key FactDetail
Service Type

Medical And Surgical Supplies

Ostomy Pouches and Supplies

Complexity LevelLow

National average reimbursement for HCPCS A4390 by major payers:

bcbs

$11.24

uhc

$7.10

aetna

$9.13

cigna

$15.83

Preview provider-level rates for...
For billing codeHCPCS A4390
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for HCPCS A4390

United
A4390$6.401790888089 - HOSPITAL AUTHORITY OF CANDLER COUNTY, CANDLER COUNTY HOSPITAL586004640GACritical Access Hospital (282NC0060X)
United
A4390$5.691073515912 - MARK VITAL760512625 - HEA CLINIC, P.A.TXOphthalmology Physician (207W00000X)
United
A4390$22.631598964082 - EMORY HEALTHCARE582030692 - EMORY UNIVERSITYGAGeneral Acute Care Hospital (282N00000X)
United
A4390$6.251326191180 - PROFESSIONAL RESOURCES MANAGEMENT OF RABUN, LLC, MOUNTAIN LAKES MEDICAL CENTER202012765GACritical Access Hospital (282NC0060X)
United
A4390$9.071518912666 - STEPHENS COUNTY ANESTHESIA SERVICES,LLC300429607 - (GA) STEPHENS COUNTY ANESTHESIA SERVICESLLCGARural Acute Care Hospital (282NR1301X)
United
A4390$5.261427189927 - DEVON DANEY271495988 - (NM) AZTEC URGENT CARE LLCCOFamily Medicine Physician (207Q00000X)
United
A4390$6.251790715381 - NORTHSIDE HOSPITAL, INC., NORTHSIDE HOSPITAL DULUTH582002413GAGeneral Acute Care Hospital (282N00000X)
United
A4390$22.631225281603 - EMORY CRAWFORD LONG HOSPITAL581537752 - EMORY UNIVERSITYGAGeneral Acute Care Hospital (282N00000X)
United
A4390$19.231992799050 - GRADY MEMORIAL HOSPITAL CORPORATION, GRADY HEALTH SYSTEMS581537752 - EMORY UNIVERSITYGAGeneral Acute Care Hospital (282N00000X)
United
A4390$6.251326028978 - CHATUGE REGIONAL HOSPITAL INC582513901 - CHATUGE REGIONAL HOSPITAL INCGACritical Access Hospital (282NC0060X)
United
A4390$6.401811962756 - EFFINGHAM HOSPITAL, INC., EFFINGHAM HEALTH SYSTEM474393589 - (GA) EFFINGHAM HOSPITAL INCGACritical Access Hospital (282NC0060X)
United
A4390$23.441073502985 - CHU CHEN42484572MAPediatrics Physician (208000000X)
United
A4390$24.541073502985 - CHU CHEN42484572MAPediatrics Physician (208000000X)
United
A4390$24.551073502985 - CHU CHEN42484572MAPediatrics Physician (208000000X)
United
A4390$23.441073502985 - CHU CHEN42484572MAPediatrics Physician (208000000X)
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 A4390 vs. Other Ostomy Pouches and Supplies Codes

The HCPCS A4390 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 A4390 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
A4389-HCPCSLowOstomy pouch, drainable, with barrier attached, with built-in convexity (1-piece), each
A4390-HCPCSLowOstomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1-piece), each
A4391-HCPCSLowOstomy pouch, urinary, with extended wear barrier attached (1-piece), each

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS A4390. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the A4390 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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