Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each
Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)
Medically Unlikely Edits (effective October 1, 2026)
Practitioner: max 1 units per day (clinical), rationale: Clinical: CMS Workgroup
Outpatient hospital: max 1 units per day (clinical), rationale: Clinical: CMS Workgroup
Medicare pricing for A4408
DMEPOS fee schedule, July 2026 (DME26-C)
no modifier, ostomy, tracheostomy and urological (OS): non-rural $14.07 in the contiguous states; $14.07 to $16.87 in AK, HI, PR and VI; ceiling $14.07, floor $11.96
Physician Fee Schedule (CY 2026, RVU26D)
Status X: statutory exclusion, not paid under the PFS.
Payer policies and prior authorization for A4408
1 of 1 payer prior-auth lists that name A4408 require prior authorization or set conditions: Medicare.
Payer
Plan
State
Prior auth
Conditions
Since
Source
Medicare
DMEPOS Master List (items potentially subject to PA)
All
prior auth under conditions
On the Master List; PA only if CMS selects it for the Required List
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.