A4377 — Ostomy pouch, drainable, for use on faceplate, plastic, each
A4377 is a HCPCS Level II code for ostomy pouch, drainable, for use on faceplate, plastic, each. It belongs to the Transportation, Medical & Surgical Supplies, Administrative section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of A4377 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 2 units MAI 3 — Date of Service Edit: Clinical · Clinical: CMS Workgroup
- outpatient
- 2 units MAI 3 — Date of Service Edit: Clinical · Clinical: CMS Workgroup
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for A4377
- Long descriptor
- Ostomy pouch, drainable, for use on faceplate, plastic, each
- Short descriptor
- Drainable plstic pch w/o fp
- Added
- January 1, 2000
- BETOS
- D1F
- Pricing indicator
- 37 — DMEPOS
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Ostomy, tracheostomy and urological supplies. Price subject to floors and ceilings.
Codes adjacent to A4377
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A4377 is not quite right, the correct code is very often within a few positions of it.
- A4367Ostomy belt, each
- A4368Ostomy filter, any type, each
- A4369Ostomy skin barrier, liquid (spray, brush, etc.), per oz
- A4371Ostomy skin barrier, powder, per oz
- A4372Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, each
- A4373Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each
- A4375Ostomy pouch, drainable, with faceplate attached, plastic, each
- A4376Ostomy pouch, drainable, with faceplate attached, rubber, each
- A4378Ostomy pouch, drainable, for use on faceplate, rubber, each
- A4379Ostomy pouch, urinary, with faceplate attached, plastic, each
- A4380Ostomy pouch, urinary, with faceplate attached, rubber, each
- A4381Ostomy pouch, urinary, for use on faceplate, plastic, each
- A4382Ostomy pouch, urinary, for use on faceplate, heavy plastic, each
- A4383Ostomy pouch, urinary, for use on faceplate, rubber, each
- A4384Ostomy faceplate equivalent, silicone ring, each
- A4385Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each
Questions about A4377
What is HCPCS code A4377?
A4377 is a HCPCS Level II code for ostomy pouch, drainable, for use on faceplate, plastic, each. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A4377?
The CMS HCPCS file marks A4377 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is A4377 paid under the physician fee schedule?
A4377 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.