A5081 HCPCS code: Stoma plug or seal, any type
A5081 is the HCPCS Level II code for stoma plug or seal, any type. The 2026 Medicare DMEPOS fee schedule pays $2.15 to $5.53 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 2 per day on outpatient hospital claims. Medicare volume rose 143% from 2022 to 2024 (18,034 to 43,803 services). In 2024, 42 suppliers billed Medicare for A5081 (purchases), serving 557 beneficiaries; California, New York, Florida accounted for 34% of services. Its average fee ranks 10 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 | 2014-01-01 |
2026 Medicare DMEPOS fee schedule for A5081
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $2.15 | $5.53 | $4.72 | $4.01 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $5.18 | — |
| AL | — | $4.72 | — |
| AR | — | $4.01 | — |
| AZ | — | $4.01 | — |
| CA | — | $4.72 | — |
| CO | — | $4.72 | — |
| CT | — | $4.72 | — |
| DC | — | $4.72 | — |
| DE | — | $4.72 | — |
| FL | — | $4.72 | — |
| GA | — | $4.01 | — |
| HI | — | $5.53 | — |
| IA | — | $4.72 | — |
| ID | — | $4.01 | — |
| IL | — | $4.72 | — |
| IN | — | $4.01 | — |
| KS | — | $4.72 | — |
| KY | — | $4.45 | — |
| LA | — | $4.01 | — |
| MA | — | $4.72 | — |
| MD | — | $4.72 | — |
| ME | — | $4.72 | — |
| MI | — | $4.01 | — |
| MN | — | $4.72 | — |
| MO | — | $4.72 | — |
| MS | — | $4.01 | — |
| MT | — | $4.01 | — |
| NC | — | $4.15 | — |
| ND | — | $4.01 | — |
| NE | — | $4.72 | — |
| NH | — | $4.72 | — |
| NJ | — | $4.72 | — |
| NM | — | $4.01 | — |
| NV | — | $4.01 | — |
| NY | — | $4.72 | — |
| OH | — | $4.72 | — |
| OK | — | $4.01 | — |
| OR | — | $4.01 | — |
| PA | — | $4.72 | — |
| PR | — | $2.15 | — |
| RI | — | $4.72 | — |
| SC | — | $4.01 | — |
| SD | — | $4.01 | — |
| TN | — | $4.54 | — |
| TX | — | $4.01 | — |
| UT | — | $4.01 | — |
| VA | — | $4.01 | — |
| VI | — | $4.72 | — |
| VT | — | $4.72 | — |
| WA | — | $4.01 | — |
| WI | — | $4.72 | — |
| WV | — | $4.72 | — |
| WY | — | $4.01 | — |
How the A5081 fee compares
| Measure | Value |
|---|---|
| Rank among 17 A50 codes (lowest = 1) | 10 |
| Family fee range (average of state fees) | $0.92–$15.72 |
| Rural fee uplift | — |
Who bills A5081 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 42 |
| Referring clinicians | 487 |
| Medicare beneficiaries | 557 |
| States with claims | 25 |
| Share of services in top 3 states (California, New York, Florida) | 34% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 35 | 268 |
| 2023 | 43 | 445 |
| 2024 | 42 | 557 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A5081, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 18,034 | 268 | $3.79 | $2.93 |
| 2023 | 34,726 | 445 | $4.10 | $3.16 |
| 2024 | 43,803 | 557 | $4.26 | $3.29 |
States with the most A5081 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 5,650 | $3.43 |
| New York | 5,090 | $3.49 |
| Florida | 3,430 | $3.43 |
| Pennsylvania | 2,370 | $3.46 |
| Massachusetts | 2,310 | $3.54 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Clinical: CMS Workgroup |
What changed for A5081
- 2026-01-01: Average state fee rose 1.9%: $4.31 to $4.39
- 1990-01-01: A5081 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 A5081?
A5081 is the HCPCS Level II code for stoma plug or seal, any type. Short descriptor: "Stoma plug or seal, any type".
How much does Medicare pay for A5081?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $2.15–$5.53. Rural fees can be higher.
Does Medicare cover A5081?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for A5081 change in 2026?
The average non-rural state fee moved from $4.31 in 2025 to $4.39 in 2026 (+1.9%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A5081 can be billed per day?
2 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)
- 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)
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 A5081
- Watch A5081 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A5081
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.