A5131 HCPCS code: Appliance cleaner, incontinence and ostomy appliances, per 16 oz.
A5131 is the HCPCS Level II code for appliance cleaner, incontinence and ostomy appliances, per 16 oz.. The 2026 Medicare DMEPOS fee schedule pays $19.20 to $72.12 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 3 per day on DME suppliers. Medicare volume fell 44% from 2022 to 2024 (22,487 to 12,571 services). In 2024, 194 suppliers billed Medicare for A5131 (purchases), serving 2,152 beneficiaries; Colorado, California, Florida accounted for 32% of services. Its average fee ranks 6 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 | 1990-01-01 |
2026 Medicare DMEPOS fee schedule for A5131
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $19.20 | $72.12 | $22.59 | $19.20 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $23.75 | — |
| AL | — | $22.59 | — |
| AR | — | $19.20 | — |
| AZ | — | $19.20 | — |
| CA | — | $22.59 | — |
| CO | — | $22.59 | — |
| CT | — | $22.59 | — |
| DC | — | $22.59 | — |
| DE | — | $22.59 | — |
| FL | — | $19.20 | — |
| GA | — | $22.59 | — |
| HI | — | $25.40 | — |
| IA | — | $19.20 | — |
| ID | — | $19.20 | — |
| IL | — | $20.62 | — |
| IN | — | $19.96 | — |
| KS | — | $19.20 | — |
| KY | — | $22.57 | — |
| LA | — | $19.20 | — |
| MA | — | $22.59 | — |
| MD | — | $22.59 | — |
| ME | — | $22.59 | — |
| MI | — | $19.20 | — |
| MN | — | $19.20 | — |
| MO | — | $22.59 | — |
| MS | — | $22.59 | — |
| MT | — | $20.88 | — |
| NC | — | $20.60 | — |
| ND | — | $22.59 | — |
| NE | — | $19.20 | — |
| NH | — | $22.59 | — |
| NJ | — | $22.59 | — |
| NM | — | $22.59 | — |
| NV | — | $19.65 | — |
| NY | — | $22.59 | — |
| OH | — | $19.20 | — |
| OK | — | $22.59 | — |
| OR | — | $19.20 | — |
| PA | — | $22.59 | — |
| PR | — | $72.12 | — |
| RI | — | $22.59 | — |
| SC | — | $19.20 | — |
| SD | — | $22.59 | — |
| TN | — | $20.61 | — |
| TX | — | $22.59 | — |
| UT | — | $22.59 | — |
| VA | — | $19.20 | — |
| VI | — | $22.59 | — |
| VT | — | $22.59 | — |
| WA | — | $19.70 | — |
| WI | — | $19.20 | — |
| WV | — | $19.20 | — |
| WY | — | $22.59 | — |
How the A5131 fee compares
| Measure | Value |
|---|---|
| Rank among 9 A51 codes (lowest = 1) | 6 |
| Family fee range (average of state fees) | $1.77–$56.11 |
| Rural fee uplift | — |
Who bills A5131 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 194 |
| Referring clinicians | 1,824 |
| Medicare beneficiaries | 2,152 |
| States with claims | 48 |
| Share of services in top 3 states (Colorado, California, Florida) | 32% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 206 | 3,122 |
| 2023 | 202 | 2,500 |
| 2024 | 194 | 2,152 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A5131, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 22,487 | 3,122 | $13.26 | $10.01 |
| 2023 | 14,724 | 2,500 | $18.03 | $13.59 |
| 2024 | 12,571 | 2,152 | $18.88 | $14.26 |
States with the most A5131 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Colorado | 1,589 | $3.29 |
| California | 1,297 | $15.94 |
| Florida | 1,180 | $13.88 |
| New York | 820 | $16.43 |
| Texas | 648 | $15.69 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 3 | Published Contractor Policy |
| outpatient hospital claims | 1 | Clinical: CMS Workgroup |
What changed for A5131
- 2026-01-01: Average state fee rose 2.0%: $21.84 to $22.27
- 1990-01-01: A5131 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 A5131?
A5131 is the HCPCS Level II code for appliance cleaner, incontinence and ostomy appliances, per 16 oz.. Short descriptor: "Appliance cleaner".
How much does Medicare pay for A5131?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $19.20–$72.12. Rural fees can be higher.
Does Medicare cover A5131?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for A5131 change in 2026?
The average non-rural state fee moved from $21.84 in 2025 to $22.27 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A5131 can be billed per day?
3 on DME suppliers; 1 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)
- A5126 — Adhesive or non-adhesive; disk or foam pad ($1.56–$2.56)
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 A5131
- Watch A5131 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A5131
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.