Every policy word on this page is CMS's own. Verzi adds pins, receipts, and links only.
Ostomy Supplies
LCD L33828 · CMS's HCPCS descriptor for A4362: Skin barrier; solid, 4 x 4 or equivalent; each.
Not on CMS's Required Prior Authorization List for DMEPOS on 2026-10-13. source
LCD L33828 · 7 versions, 2015 to today · last changed 2024-01-01 (R6)
Version 25 of LCD L33828: in force by CMS's dates 2022-01-01 to 2023-12-31. The policy text on this page comes from this archived version. On its start date, 2022-01-01, the companion Articles in force were Article A52487 version 33 and Article A55426 version 91.
JA · Noridian 16013
JB · CGS 17013
JC · CGS 18003
JD · Noridian 19003
source
CMS's Who are the MACs jurisdiction pages (DME facts as of 2025-09-30) name each contractor and its states; the MCD's Contractor Information table on every DME LCD prints the contract numbers. Both read 2026-10-09. Verzi adds the state lookup only.
76 more codes
Sections in this version: CMS National Coverage Policy · Coverage Indications, Limitations, and/or Medical Necessity · Summary of Evidence · Analysis of Evidence (Rationale for Determination) · Coding Information · Associated Information · Sources of Information · Bibliography
Full verbatim text serves to customers · Customer? Log in
Version history, LCD L33828
CMS numbers each version. Each box shows the version's window by CMS's stated dates. Select a version to show it on this page. Versions superseded the same day they took effect never governed a claim, so the page hides them until you ask. Version numbers CMS never published to its archive do not exist as documents.
Revision history, every version
CMS's own change log, quoted, 6 entries. It does not change with the version shown. A revision (R-number) is a change CMS logged. The version (vN) is the snapshot that carries it.
R6 · 2024-01-01 · v27
Revision Effective Date: 01/01/2024 COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY: Added: “and document an affirmative response” to language that pertains to contact with the beneficiary or caregiver/designee for DMEPOS products supplied as refills Revised: “approaching exhaustion” to “expected to end” in regard to existing supplies Revised: “Contact with the beneficiary or designee regarding refills must take place no sooner than 14 calendar days prior to the delivery/shipping date.” to “Contact with the beneficiary or designee regarding refills must take place no sooner than 30 calendar days prior to the expected end of the current supply.” Revised: “For delivery of refills, the supplier must deliver the DMEPOS product no sooner than 10 calendar days prior to the end of usage for the current product.” to “For delivery of refills, the supplier must deliver the DMEPOS product no sooner than 10 calendar days prior to the expected end of the current supply.” 12/14/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates to refill requirement information per CMS Final Rule CMS-1780-F.
R5 · 2022-01-01 · v25
Revision Effective Date: 01/01/2022 COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY: Removed: HCPCS code A4397 from Usual Maximum Quantity of Supplies table Added: HCPCS codes A4436 and A4437 to Usual Maximum Quantity of Supplies table CODING INFORMATION: Removed: HCPCS code A4397 from Group 1 Codes (invalid code on or after DOS 01/01/2022) Added: HCPCS codes A4436 and A4437 to Group 1 Codes (valid on or after DOS 01/01/2022) 12/30/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.
R4 · 2020-01-01 · v20
Revision Effective Date: 01/01/2020 GENERAL: Revised: Order information as a result of Final Rule 1713 REFILL REQUIREMENTS: Revised: “ordering physicians” to “treating practitioners” CODING INFORMATION: Removed: Field titled “Bill Type” Removed: Field titled “Revenue Codes” Removed: Field titled “ICD-10 Codes that Support Medical Necessity” Removed: Field titled “ICD-10 Codes that DO NOT Support Medical Necessity” Removed: Field titled “Additional ICD-10 Information” DOCUMENTATION REQUIREMENTS: Revised: “physician’s” to “treating practitioner’s” GENERAL DOCUMENTATION REQUIREMENTS: Revised: “Prescriptions (orders)” to “SWO” 02/20/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.
R3 · 2017-01-01 · v14
Revision History Effective Date: 01/01/2017: COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY: Removed: Standard Documentation Language Added: New reference language and directions to Standard Documentation Requirements Added: General Requirements Revised: Refill Requirements DOCUMENTATION REQUIREMENTS: Removed: Standard Documentation Language Added: General Documentation Requirements Added: New reference language and directions to Standard Documentation Requirements POLICY SPECIFIC DOCUMENTATION REQUIREMENTS: Removed: Standard Documentation Language Added: Direction to Standard Documentation Requirements Removed: Supplier Manual reference from Miscellaneous Removed: PIM reference from Appendices RELATED LOCAL COVERAGE DOCUMENTS: Added: LCD-related Standard Documentation Requirements article
R2 · 2016-07-01 · v11
Effective July 1, 2016 oversight for DME MAC LCDs is the responsibility of CGS Administrators, LLC 18003 and 17013 and Noridian Healthcare Solutions, LLC 19003 and 16013. No other changes have been made to the LCDs.
R1 · 2015-10-01 · v8
Revsion History Effective Date: 08/01/2015 COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY: Revised: Standard Documentation Language to add covered prior to a beneficiary’s Medicare eligibility DOCUMENTATION REQUIREMENTS: Removed: ICD-9 references Revised: Standard Documentation Language to add who can enter date of delivery date on the POD (Note: The effective date above is not applicable to this section. These revised and added requirements are existing Medicare requirements which are now included in the LCD for easy reference) POLICY SPECIFIC DOCUMENTATION REQUIREMENTS: Added: Language for HCPCS codes A4450, A4452 and A5120 when submitted without correct modifier
Receipts for auditors
Version 25 of LCD L33828, shown on this page: in force by CMS's dates 2022-01-01 to 2023-12-31. Archived 2026-09-26. CMS's copy · Our archived file. 8 of 8 sections are proven word-identical to the archived file.
Every archived version of LCD L33828 (7 versions, CMS's dates, window by the as-of rule).
| Document | Version | In force | Archived on | Verify |
|---|---|---|---|---|
| LCD L33828 | version 2 | 2015-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33828 | version 8 | 2015-10-01 to 2016-06-30 | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33828 | version 11 | 2016-07-01 to 2016-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33828 | version 14 | 2017-01-01 to 2019-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33828 | version 20 | 2020-01-01 to 2021-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33828 | version 25 shown | 2022-01-01 to 2023-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33828 | version 27 | 2024-01-01 to today | 2026-09-26 | CMS's copy · Our archived file |
The related Articles each have their own receipts: Article A55426 · Article A52487.
Each archived file's page gives its sha256 fingerprint. A copy of the file hashes to the same value, byte for byte.
CMS's live page shows only the current version. To check a passage by eye, open CMS's copy of the same version number. A version's window ends on the earlier of CMS's stated end date and the day before the next version starts.
Every policy word on this page is CMS's, from the archived version named beside it. Verzi adds labels, highlights, citations and links only. Verzi-written summary content on this page: none.
Governing policies, as CMS lists them:
- LCD L33828 · Ostomy Supplies
CMS lists A4362 in group 1 of version 27. CMS's description, quoted: “SKIN BARRIER; SOLID, 4 X 4 OR EQUIVALENT; EACH”.
Related Articles, as CMS lists them: Article A55426 · Article A52487
From CMS's LCD code table. HCPCS Level II codes only.
source
CMS's LCD code table in the Medicare Coverage Database download, archived 2026-10-09: Our archived file.
Watch A4362
One email when any policy cited for A4362 changes or gains a future effective date. Nothing else, ever.