A4420 Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for Ost pch clsd for bar w lk fl.
National Average Payment
Non-Facility (Private Office) Rate
A4420 Reimbursement Rate History
| Quarter | Q1 2025 | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | — | — | — | — | — | — |
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Code Description
Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each
Reimbursement Summary
CPT code A4420 (Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each) does not currently have a published national facility or non-facility reimbursement rate in 2026.
A4420 is a HCPCS Level II code in the category “DMEPOS Equipment.” Medicare does not publish a single national payment amount for this code in 2026 (No National Rate). A national base rate is not currently published.
To estimate a local payment amount when available, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage and confirm final pricing guidance through CMS or your local Medicare Administrative Contractor (MAC).
A4420 Reimbursement Rate History
| Quarter | Q1 2025 | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | — | — | — | — | — | — |
Historical Medicare Reimbursement
No published quarterly historical rates are available yet for this code.
| Quarter | Non-Facility Rate | Facility Rate | YoY % Change (Non-Fac) | YoY % Change (Fac) |
|---|---|---|---|---|
| 2026 Q2 | — | — | — | — |
| 2026 Q1 | — | — | — | — |
| 2025 Q4 | — | — | — | — |
| 2025 Q3 | — | — | — | — |
| 2025 Q2 | — | — | — | — |
| 2025 Q1 | — | — | — | — |
Q2 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | ||
| Practice Expense (PE) | ||
| Malpractice (MP) | ||
| Total RVUs | 0.00 | 0.00 |
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Medicare rates are used as a benchmark only. Actual payer contracts, modifiers, place of service, units, and billing rules may affect reimbursement. This tool is for educational and operational review purposes, not legal or billing advice.
Commercial Payer Rates for A4420
Pro FeatureNational average reimbursement from major commercial payers based on CMS Transparency in Coverage machine-readable files.
| Modifier | Place of Service | Avg. Rate | vs Medicare | Percentile Range |
|---|---|---|---|---|
| NULL | Office (11) | $91.46 | -4.0% | $80 — $104 |
| NULL | Telehealth (02) | $88.20 | -7.4% | $76 — $102 |
| NULL | Facility (21) | $79.31 | -15.6% | $68 — $95 |
| NULL | Outpatient Hospital (22) | $84.92 | -10.2% | $71 — $99 |
| NULL | Home (12) | $96.14 | +1.0% | $84 — $113 |
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Source: CMS Transparency in Coverage machine-readable files (MRFs). Commercial rates reflect payer-published negotiated amounts and may not reflect individual contracted rates.
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Facility vs. Non-Facility (Office) Payment
Facility vs. non-facility pricing most commonly applies to physician services paid under the RVU-based Physician Fee Schedule. For A4420 (DMEPOS Equipment), the payment methodology may not include both facility and non-facility rates.
Learn How This Reimbursement Is Calculated
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
Frequently Asked Questions
What is the 2026 Medicare rate for A4420?
Medicare does not publish a single national reimbursement rate for A4420 in 2026 (No National Rate). Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool to explore locality-adjusted estimates when applicable.
What is the description for code A4420?
Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each
Why do facility and non-facility payments differ for A4420?
Facility vs. non-facility differences usually apply to RVU-based physician services. A4420 may not use both facility and non-facility pricing depending on its payment methodology.
How can I find my local Medicare rate for A4420?
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Is A4420 covered by Medicare?
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.
