A5063 HCPCS code: Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each
A5063 is the HCPCS Level II code for ostomy pouch, drainable; for use on barrier with flange (2 piece system), each. The 2026 Medicare DMEPOS fee schedule pays $3.86 to $4.56 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 14% from 2022 to 2024 (3,121,680 to 2,700,190 services). In 2024, 1,518 suppliers billed Medicare for A5063 (purchases), serving 25,151 beneficiaries; New York, Florida, California accounted for 19% of services. Its average fee ranks 9 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 | 2003-01-01 |
2026 Medicare DMEPOS fee schedule for A5063
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $3.86 | $4.56 | $3.86 | $3.28 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $3.86 | — |
| AL | — | $3.86 | — |
| AR | — | $3.86 | — |
| AZ | — | $3.86 | — |
| CA | — | $3.86 | — |
| CO | — | $3.86 | — |
| CT | — | $3.86 | — |
| DC | — | $3.86 | — |
| DE | — | $3.86 | — |
| FL | — | $3.86 | — |
| GA | — | $3.86 | — |
| HI | — | $3.86 | — |
| IA | — | $3.86 | — |
| ID | — | $3.86 | — |
| IL | — | $3.86 | — |
| IN | — | $3.86 | — |
| KS | — | $3.86 | — |
| KY | — | $3.86 | — |
| LA | — | $3.86 | — |
| MA | — | $3.86 | — |
| MD | — | $3.86 | — |
| ME | — | $3.86 | — |
| MI | — | $3.86 | — |
| MN | — | $3.86 | — |
| MO | — | $3.86 | — |
| MS | — | $3.86 | — |
| MT | — | $3.86 | — |
| NC | — | $3.86 | — |
| ND | — | $3.86 | — |
| NE | — | $3.86 | — |
| NH | — | $3.86 | — |
| NJ | — | $3.86 | — |
| NM | — | $3.86 | — |
| NV | — | $3.86 | — |
| NY | — | $3.86 | — |
| OH | — | $3.86 | — |
| OK | — | $3.86 | — |
| OR | — | $3.86 | — |
| PA | — | $3.86 | — |
| PR | — | $4.56 | — |
| RI | — | $3.86 | — |
| SC | — | $3.86 | — |
| SD | — | $3.86 | — |
| TN | — | $3.86 | — |
| TX | — | $3.86 | — |
| UT | — | $3.86 | — |
| VA | — | $3.86 | — |
| VI | — | $3.86 | — |
| VT | — | $3.86 | — |
| WA | — | $3.86 | — |
| WI | — | $3.86 | — |
| WV | — | $3.86 | — |
| WY | — | $3.86 | — |
How the A5063 fee compares
| Measure | Value |
|---|---|
| Rank among 17 A50 codes (lowest = 1) | 9 |
| Family fee range (average of state fees) | $0.92–$15.72 |
| Rural fee uplift | — |
Who bills A5063 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 1,518 |
| Referring clinicians | 21,946 |
| Medicare beneficiaries | 25,151 |
| States with claims | 52 |
| Share of services in top 3 states (New York, Florida, California) | 19% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 1,853 | 29,104 |
| 2023 | 1,657 | 27,000 |
| 2024 | 1,518 | 25,151 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A5063, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 3,121,680 | 29,104 | $3.30 | $2.48 |
| 2023 | 2,867,572 | 27,000 | $3.59 | $2.70 |
| 2024 | 2,700,190 | 25,151 | $3.68 | $2.78 |
States with the most A5063 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New York | 177,108 | $2.80 |
| Florida | 172,253 | $2.80 |
| California | 155,375 | $2.78 |
| Pennsylvania | 124,230 | $2.75 |
| Illinois | 114,745 | $2.79 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Clinical: CMS Workgroup |
What changed for A5063
- 2026-01-01: Average state fee rose 2.1%: $3.79 to $3.87
- 1990-01-01: A5063 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 A5063?
A5063 is the HCPCS Level II code for ostomy pouch, drainable; for use on barrier with flange (2 piece system), each. Short descriptor: "Drain ostomy pouch w/flange".
How much does Medicare pay for A5063?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $3.86–$4.56. Rural fees can be higher.
Does Medicare cover A5063?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for A5063 change in 2026?
The average non-rural state fee moved from $3.79 in 2025 to $3.87 in 2026 (+2.1%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A5063 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)
- A5055 — Stoma cap ($1.74–$2.19)
- 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)
- 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 A5063
- Watch A5063 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A5063
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.