A5055 HCPCS code: Stoma cap
A5055 is the HCPCS Level II code for stoma cap. The 2026 Medicare DMEPOS fee schedule pays $1.74 to $2.19 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 1 per day on outpatient hospital claims. Medicare volume fell 17% from 2022 to 2024 (161,797 to 134,804 services). In 2024, 121 suppliers billed Medicare for A5055 (purchases), serving 871 beneficiaries; California, Florida, New York accounted for 25% of services. Its average fee ranks 2 of 17 A50 codes (family range $0.92–$15.72).
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 37 — DMEPOS: ostomy, tracheostomy and urological supplies |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1990-01-01 |
| Last action effective | 1990-01-01 |
2026 Medicare DMEPOS fee schedule for A5055
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1.74 | $2.19 | $2.05 | $1.74 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $1.99 | — |
| AL | — | $2.05 | — |
| AR | — | $2.05 | — |
| AZ | — | $1.99 | — |
| CA | — | $1.90 | — |
| CO | — | $2.01 | — |
| CT | — | $2.02 | — |
| DC | — | $2.05 | — |
| DE | — | $2.02 | — |
| FL | — | $2.05 | — |
| GA | — | $2.05 | — |
| HI | — | $2.09 | — |
| IA | — | $2.05 | — |
| ID | — | $1.99 | — |
| IL | — | $2.05 | — |
| IN | — | $2.05 | — |
| KS | — | $2.02 | — |
| KY | — | $2.05 | — |
| LA | — | $2.05 | — |
| MA | — | $2.05 | — |
| MD | — | $2.05 | — |
| ME | — | $2.05 | — |
| MI | — | $2.05 | — |
| MN | — | $2.05 | — |
| MO | — | $2.05 | — |
| MS | — | $1.87 | — |
| MT | — | $1.99 | — |
| NC | — | $1.76 | — |
| ND | — | $2.02 | — |
| NE | — | $2.02 | — |
| NH | — | $2.05 | — |
| NJ | — | $2.02 | — |
| NM | — | $2.05 | — |
| NV | — | $2.05 | — |
| NY | — | $2.02 | — |
| OH | — | $1.88 | — |
| OK | — | $2.05 | — |
| OR | — | $2.05 | — |
| PA | — | $2.02 | — |
| PR | — | $2.19 | — |
| RI | — | $2.02 | — |
| SC | — | $1.90 | — |
| SD | — | $2.02 | — |
| TN | — | $1.74 | — |
| TX | — | $1.99 | — |
| UT | — | $1.85 | — |
| VA | — | $2.05 | — |
| VI | — | $2.02 | — |
| VT | — | $2.05 | — |
| WA | — | $2.05 | — |
| WI | — | $2.05 | — |
| WV | — | $1.88 | — |
| WY | — | $2.02 | — |
How the A5055 fee compares
| Measure | Value |
|---|---|
| Rank among 17 A50 codes (lowest = 1) | 2 |
| Family fee range (average of state fees) | $0.92–$15.72 |
| Rural fee uplift | — |
Who bills A5055 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 121 |
| Referring clinicians | 908 |
| Medicare beneficiaries | 871 |
| States with claims | 41 |
| Share of services in top 3 states (California, Florida, New York) | 25% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 130 | 1,029 |
| 2023 | 129 | 969 |
| 2024 | 121 | 871 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A5055, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 161,797 | 1,029 | $1.71 | $1.27 |
| 2023 | 146,358 | 969 | $1.85 | $1.38 |
| 2024 | 134,804 | 871 | $1.91 | $1.43 |
States with the most A5055 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 14,635 | $1.36 |
| Florida | 9,760 | $1.45 |
| New York | 8,290 | $1.48 |
| Texas | 7,326 | $1.44 |
| Pennsylvania | 5,062 | $1.40 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Clinical: CMS Workgroup |
What changed for A5055
- 2026-01-01: Average state fee rose 2.0%: $1.97 to $2.01
- 1990-01-01: A5055 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code A5055?
A5055 is the HCPCS Level II code for stoma cap. Short descriptor: "Stoma cap".
How much does Medicare pay for A5055?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1.74–$2.19. Rural fees can be higher.
Does Medicare cover A5055?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for A5055 change in 2026?
The average non-rural state fee moved from $1.97 in 2025 to $2.01 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A5055 can be billed per day?
1 on outpatient hospital claims (NCCI medically unlikely edits).
Related A50 codes
- A5051 — Ostomy pouch, closed; with barrier attached (1 piece), each ($2.94–$3.54)
- A5052 — Ostomy pouch, closed; without barrier attached (1 piece), each ($2.12–$2.57)
- A5053 — Ostomy pouch, closed; for use on faceplate, each ($1.75–$3.07)
- A5054 — Ostomy pouch, closed; for use on barrier with flange (2 piece), each ($2.56–$3.04)
- A5056 — Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each ($6.66–$7.29)
- A5057 — Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each ($13.68–$15.03)
- A5061 — Ostomy pouch, drainable; with barrier attached, (1 piece), each ($5.04–$6.03)
- A5062 — Ostomy pouch, drainable; without barrier attached (1 piece), each ($2.96–$3.34)
- A5063 — Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each ($3.86–$4.56)
- A5071 — Ostomy pouch, urinary; with barrier attached (1 piece), each ($8.57–$10.34)
- A5072 — Ostomy pouch, urinary; without barrier attached (1 piece), each ($4.28–$6.05)
- A5073 — Ostomy pouch, urinary; for use on barrier with flange (2 piece), each ($3.85–$5.07)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under A5055
- Watch A5055 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A5055
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.