`A4358` Urinary leg or abdomen bag

Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 6 units per day (clinical), rationale: Clinical: Data
DME supplier: max 6 units per day (clinical), rationale: Published Contractor Policy

Medicare pricing for A4358

DMEPOS fee schedule, July 2026 (DME26-C)

no modifier, ostomy, tracheostomy and urological (OS): non-rural $8.04 to $9.46 in the contiguous states; $7.92 to $10.04 in AK, HI, PR and VI; ceiling $9.46, floor $8.04

Physician Fee Schedule (CY 2026, RVU26D)

Status P: bundled or excluded, no separate PFS payment.

Payer policies and prior authorization for A4358

Payer coverage policies that name A4358

A4358 appears in 1 coverage policy from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Urological Supplies (0533)	covered if criteria are met	Jul 30, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in KY, LA, MA, OH, VA, WV.

AZ: $10.01 (dme), effective Oct 1, 2026
CO: $6.49 (chp_plus, non-facility), effective Jul 1, 2026
FL: $3.65 (dme), effective Jul 1, 2026
IL: $6.30 (dme), effective Jan 1, 2026
IN: $3.79 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2014
KS: $7.57 (default), effective Jul 1, 2026
KY: $5.39 (dme), effective Jan 1, 2026
LA: $4.05 (dme), effective Jul 1, 2012
MA: $7.69 (dme_rates), effective Mar 1, 2026
MD: $8.04 (dme), effective Apr 1, 2026
MS: $6.74 (comprehensive), effective Jul 1, 2026
ND: $11.10 (dme), effective Aug 1, 2026
NE: $8.27 (dme), effective Jul 1, 2026
NY: $4.17 (dme), effective Jul 1, 2026
OH: $6.57 (dme), effective Jan 1, 2024
OK: $9.46 (dme), effective Jan 1, 2026
TX: $6.23 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective Apr 1, 2017
VA: $8.51 (dme), effective Dec 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $6.91 (medical_equipment_supplies), effective Jul 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

A4358 Urinary leg or abdomen bag