A5056 HCPCS code: Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each
A5056 is the HCPCS Level II code for ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each. The 2026 Medicare DMEPOS fee schedule pays $6.66 to $7.29 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 120 per day on DME suppliers. Medicare volume rose 13% from 2022 to 2024 (732,232 to 825,693 services). In 2024, 548 suppliers billed Medicare for A5056 (purchases), serving 6,653 beneficiaries; California, Texas, Pennsylvania accounted for 24% of services. Its average fee ranks 14 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 | 2012-01-01 |
| Last action effective | 2012-01-01 |
2026 Medicare DMEPOS fee schedule for A5056
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $6.66 | $7.29 | $6.66 | $5.66 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $6.66 | — |
| AL | — | $6.66 | — |
| AR | — | $6.66 | — |
| AZ | — | $6.66 | — |
| CA | — | $6.66 | — |
| CO | — | $6.66 | — |
| CT | — | $6.66 | — |
| DC | — | $6.66 | — |
| DE | — | $6.66 | — |
| FL | — | $6.66 | — |
| GA | — | $6.66 | — |
| HI | — | $6.66 | — |
| IA | — | $6.66 | — |
| ID | — | $6.66 | — |
| IL | — | $6.66 | — |
| IN | — | $6.66 | — |
| KS | — | $6.66 | — |
| KY | — | $6.66 | — |
| LA | — | $6.66 | — |
| MA | — | $6.66 | — |
| MD | — | $6.66 | — |
| ME | — | $6.66 | — |
| MI | — | $6.66 | — |
| MN | — | $6.66 | — |
| MO | — | $6.66 | — |
| MS | — | $6.66 | — |
| MT | — | $6.66 | — |
| NC | — | $6.66 | — |
| ND | — | $6.66 | — |
| NE | — | $6.66 | — |
| NH | — | $6.66 | — |
| NJ | — | $6.66 | — |
| NM | — | $6.66 | — |
| NV | — | $6.66 | — |
| NY | — | $6.66 | — |
| OH | — | $6.66 | — |
| OK | — | $6.66 | — |
| OR | — | $6.66 | — |
| PA | — | $6.66 | — |
| PR | — | $7.29 | — |
| RI | — | $6.66 | — |
| SC | — | $6.66 | — |
| SD | — | $6.66 | — |
| TN | — | $6.66 | — |
| TX | — | $6.66 | — |
| UT | — | $6.66 | — |
| VA | — | $6.66 | — |
| VI | — | $6.66 | — |
| VT | — | $6.66 | — |
| WA | — | $6.66 | — |
| WI | — | $6.66 | — |
| WV | — | $6.66 | — |
| WY | — | $6.66 | — |
How the A5056 fee compares
| Measure | Value |
|---|---|
| Rank among 17 A50 codes (lowest = 1) | 14 |
| Family fee range (average of state fees) | $0.92–$15.72 |
| Rural fee uplift | — |
Who bills A5056 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 548 |
| Referring clinicians | 5,896 |
| Medicare beneficiaries | 6,653 |
| States with claims | 51 |
| Share of services in top 3 states (California, Texas, Pennsylvania) | 24% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 540 | 6,057 |
| 2023 | 535 | 6,423 |
| 2024 | 548 | 6,653 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A5056, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 732,232 | 6,057 | $5.71 | $4.28 |
| 2023 | 771,754 | 6,423 | $6.21 | $4.67 |
| 2024 | 825,693 | 6,653 | $6.37 | $4.79 |
States with the most A5056 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 87,020 | $4.78 |
| Texas | 70,954 | $4.77 |
| Pennsylvania | 39,832 | $4.76 |
| Illinois | 37,893 | $4.79 |
| Ohio | 34,756 | $4.83 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 120 | Published Contractor Policy |
| outpatient hospital claims | 90 | Clinical: Data |
| practitioner claims | 90 | Clinical: Data |
What changed for A5056
- 2026-01-01: Average state fee rose 2.0%: $6.54 to $6.67
- 2012-01-01: A5056 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 A5056?
A5056 is the HCPCS Level II code for ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each. Short descriptor: "1 pc ost pouch w filter".
How much does Medicare pay for A5056?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $6.66–$7.29. Rural fees can be higher.
Does Medicare cover A5056?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for A5056 change in 2026?
The average non-rural state fee moved from $6.54 in 2025 to $6.67 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A5056 can be billed per day?
120 on DME suppliers; 90 on outpatient hospital claims; 90 on practitioner 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)
- A5055 — Stoma cap ($1.74–$2.19)
- 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)
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Next steps
- Run a reimbursement report for a device billed under A5056
- Watch A5056 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A5056
Sources: CMS HCPCS Level II release October 2026; 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.