A4431 — Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each
A4431 is a HCPCS Level II code for ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (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 A4431 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
- 1 unit MAI 3 — Date of Service Edit: Clinical · Clinical: CMS Workgroup
- outpatient
- 1 unit 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 A4431
- Long descriptor
- Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each
- Short descriptor
- Ost pch urine w barrier/tapv
- 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 A4431
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A4431 is not quite right, the correct code is very often within a few positions of it.
- 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
- A4425Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each
- A4426Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each
- A4427Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each
- A4428Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each
- A4429Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each
- A4430Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each
- A4432Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each
- A4433Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each
- A4434Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each
- A4435Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each
- A4436Irrigation supply; sleeve, reusable, per month
- A4437Irrigation supply; sleeve, disposable, per month
- A4438Adhesive clip applied to the skin to secure external electrical nerve stimulator controller, each
- A4450Tape, non-waterproof, per 18 square inches
Questions about A4431
What is HCPCS code A4431?
A4431 is a HCPCS Level II code for ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A4431?
The CMS HCPCS file marks A4431 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 A4431 paid under the physician fee schedule?
A4431 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.