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See a sample rate comparisonHCPCS A4431 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, urinary; with barrier attached, with faucet-type tap with valve (1-piece), each
| Key Fact | Detail |
|---|---|
| Service Type | Medical And Surgical Supplies Ostomy Pouches and Supplies |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for A4431 |
National average reimbursement for HCPCS A4431 by major payers:
$7.42
$4.60
$5.98
$7.42
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HCPCS A4431
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$15.88Published rateKelly Ridges
Allergy & Asthma Of Dupage, S.C.
$8.47Published rateUpson County Hospital Inc, Upson Regional Medical Center
Upson County Hospital Inc
$4.32Published rateNavicent Health Oconee, LLC, Navicent Health Baldwin
Navicent Health Oconee LLC
$4.03Published rateWildwood Sanitarium Incorporated, Wildwood Medical Clinic
Wildwood Sanitarium Incorporated
$2.89Published rate
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See a sample payer proposalHCPCS A4431 vs. Other Ostomy Pouches and Supplies Codes
The HCPCS A4431 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 A4431 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 |
|---|---|---|
| A4430-HCPCS | Low | Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1-piece), each |
| A4431-HCPCS | Low | Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1-piece), each |
| A4432-HCPCS | Low | Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2-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 A4431. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the A4431 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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