A4416 — Ostomy pouch, closed, with barrier attached, with filter (1 piece), each
A4416 is a HCPCS Level II code for ostomy pouch, closed, with barrier attached, with filter (1 piece), each. It belongs to the Transportation, Medical & Surgical Supplies, Administrative section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
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 A4416 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 A4416
- Long descriptor
- Ostomy pouch, closed, with barrier attached, with filter (1 piece), each
- Short descriptor
- Ost pch clsd w barrier/filtr
- Added
- January 1, 2004
- 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 A4416
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A4416 is not quite right, the correct code is very often within a few positions of it.
- A4408Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each
- A4409Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each
- A4410Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each
- A4411Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each
- A4412Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each
- A4413Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each
- A4414Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each
- A4415Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each
- A4417Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each
- A4418Ostomy pouch, closed; without barrier attached, with filter (1 piece), each
- A4419Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each
- A4420Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each
- A4421Ostomy supply; miscellaneous
- A4422Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each
- A4423Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each
- A4424Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each
Questions about A4416
What is HCPCS code A4416?
A4416 is a HCPCS Level II code for ostomy pouch, closed, with barrier attached, with filter (1 piece), each. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A4416?
The CMS HCPCS file marks A4416 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is A4416 paid under the physician fee schedule?
A4416 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.