A5126 HCPCS code: Adhesive or non-adhesive; disk or foam pad
A5126 is the HCPCS Level II code for adhesive or non-adhesive; disk or foam pad. The 2026 Medicare DMEPOS fee schedule pays $1.56 to $2.56 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 2 per day on outpatient hospital claims. Medicare volume fell 8% from 2022 to 2024 (14,458 to 13,234 services). In 2024, 45 suppliers billed Medicare for A5126 (purchases), serving 134 beneficiaries; California, Ohio, Wisconsin accounted for 29% of services. Its average fee ranks 1 of 9 A51 codes (family range $1.77–$56.11).
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 | 2000-01-01 |
2026 Medicare DMEPOS fee schedule for A5126
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1.56 | $2.56 | $1.87 | $1.59 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $1.56 | — |
| AL | — | $1.85 | — |
| AR | — | $1.87 | — |
| AZ | — | $1.87 | — |
| CA | — | $1.59 | — |
| CO | — | $1.87 | — |
| CT | — | $1.87 | — |
| DC | — | $1.87 | — |
| DE | — | $1.87 | — |
| FL | — | $1.59 | — |
| GA | — | $1.87 | — |
| HI | — | $1.64 | — |
| IA | — | $1.87 | — |
| ID | — | $1.59 | — |
| IL | — | $1.59 | — |
| IN | — | $1.70 | — |
| KS | — | $1.87 | — |
| KY | — | $1.59 | — |
| LA | — | $1.87 | — |
| MA | — | $1.87 | — |
| MD | — | $1.87 | — |
| ME | — | $1.87 | — |
| MI | — | $1.59 | — |
| MN | — | $1.59 | — |
| MO | — | $1.87 | — |
| MS | — | $1.87 | — |
| MT | — | $1.87 | — |
| NC | — | $1.59 | — |
| ND | — | $1.87 | — |
| NE | — | $1.87 | — |
| NH | — | $1.87 | — |
| NJ | — | $1.87 | — |
| NM | — | $1.59 | — |
| NV | — | $1.87 | — |
| NY | — | $1.59 | — |
| OH | — | $1.59 | — |
| OK | — | $1.59 | — |
| OR | — | $1.59 | — |
| PA | — | $1.87 | — |
| PR | — | $2.56 | — |
| RI | — | $1.87 | — |
| SC | — | $1.59 | — |
| SD | — | $1.87 | — |
| TN | — | $1.59 | — |
| TX | — | $1.87 | — |
| UT | — | $1.87 | — |
| VA | — | $1.64 | — |
| VI | — | $1.59 | — |
| VT | — | $1.87 | — |
| WA | — | $1.63 | — |
| WI | — | $1.87 | — |
| WV | — | $1.59 | — |
| WY | — | $1.87 | — |
How the A5126 fee compares
| Measure | Value |
|---|---|
| Rank among 9 A51 codes (lowest = 1) | 1 |
| Family fee range (average of state fees) | $1.77–$56.11 |
| Rural fee uplift | — |
Who bills A5126 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 45 |
| Referring clinicians | 140 |
| Medicare beneficiaries | 134 |
| States with claims | 17 |
| Share of services in top 3 states (California, Ohio, Wisconsin) | 29% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 55 | 165 |
| 2023 | 52 | 151 |
| 2024 | 45 | 134 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A5126, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 14,458 | 165 | $1.45 | $1.06 |
| 2023 | 12,909 | 151 | $1.60 | $1.19 |
| 2024 | 13,234 | 134 | $1.62 | $1.19 |
States with the most A5126 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 1,230 | $1.11 |
| Ohio | 895 | $1.19 |
| Wisconsin | 770 | $1.40 |
| Massachusetts | 750 | $1.13 |
| New York | 740 | $1.02 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Clinical: CMS Workgroup |
What changed for A5126
- 2026-01-01: Average state fee rose 2.1%: $1.73 to $1.77
- 1990-01-01: A5126 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 A5126?
A5126 is the HCPCS Level II code for adhesive or non-adhesive; disk or foam pad. Short descriptor: "Disk/foam pad +or- adhesive".
How much does Medicare pay for A5126?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1.56–$2.56. Rural fees can be higher.
Does Medicare cover A5126?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for A5126 change in 2026?
The average non-rural state fee moved from $1.73 in 2025 to $1.77 in 2026 (+2.1%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A5126 can be billed per day?
2 on outpatient hospital claims (NCCI medically unlikely edits).
Related A51 codes
- A5102 — Bedside drainage bottle with or without tubing, rigid or expandable, each ($27.85–$35.14)
- A5105 — Urinary suspensory with leg bag, with or without tube, each ($28.84–$91.13)
- A5112 — Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each ($41.95–$61.74)
- A5113 — Leg strap; latex, replacement only, per set ($4.96–$8.91)
- A5114 — Leg strap; foam or fabric, replacement only, per set ($8.91–$26.83)
- A5120 — Skin barrier, wipes or swabs, each ($0.14–$0.39)
- A5121 — Skin barrier; solid, 6 x 6 or equivalent, each ($5.90–$12.99)
- A5122 — Skin barrier; solid, 8 x 8 or equivalent, each ($15.56–$21.69)
- A5131 — Appliance cleaner, incontinence and ostomy appliances, per 16 oz. ($19.20–$72.12)
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 A5126
- Watch A5126 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A5126
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.