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HCPCS A5057 · Level II · A code

A5057: Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, HCPCS Level II A code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); DMEPOS fee schedule: DME26-D (October 2026) (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and DMEPOS fee schedule and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for A5057

Medicare payment
$13.68
DMEPOS non-rural state fees
Coverage code
D
special coverage instructions apply
DME supplier MUE
120
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 0

TL;DR

HCPCS Level II A5057 reads "Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each" in the October 2026 file; it dates from 2012. The October 2026 DMEPOS fee schedule (category OS, ostomy, tracheostomy and urological items) sets A5057 at $13.68 in every contiguous state (floor $11.63, ceiling $13.68). CMS caps A5057 at practitioner 90 (MAI 3, Clinical: Data); hospital outpatient 90 (MAI 3, Clinical: Data); DME supplier 120 (MAI 3, Published Contractor Policy) units per day in the 2026 Q4 MUE tables. 1 active LCD lists A5057: L33828 (Ostomy Supplies). OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS D1F (prosthetic/orthotic devices); pricing indicator 37; type of service P (lump-sum purchase of DME, prosthetics or orthotics). 47 other active codes open with "Ostomy pouch"; related codes: A5063, A4390, A5056, A5054.

A5057 descriptor and code status

The October 2026 HCPCS Level II file describes A5057 as “Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each”. It sits in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), listed with the other A codes.

HCPCS file attributes of A5057
FieldValue
Short descriptor1 pc ost pou w built-in conv
Added to HCPCS2012-01-01
Last actionN (no maintenance), effective 2012-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator37: DMEPOS ostomy, tracheostomy and urological supplies (floors and ceilings)
BETOS categoryD1F: prosthetic/orthotic devices
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for A5057

The October 2026 DMEPOS fee schedule (category OS, ostomy, tracheostomy and urological items) sets A5057 at $13.68 in every contiguous state (floor $11.63, ceiling $13.68). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status X: statutory exclusion: not a physician service under the fee schedule. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

DMEPOS fee schedule (DME26-D)

Jurisdiction D (DME MAC), payment category OS (ostomy, tracheostomy and urological items). Fees are set per state; AK, HI, PR and VI are not subject to the national ceiling and floor and are listed separately. A rural fee applies only in ZIP codes on the CMS rural ZIP list.

DMEPOS fees for A5057 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none$11.63 / $13.68$13.68 (49 states)—AK $13.85, HI $14.82, PR $15.03, VI $13.68

Hospital outpatient (OPPS Addendum B)

Status indicator N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Medically Unlikely Edits for A5057

CMS caps A5057 at practitioner 90 (MAI 3, Clinical: Data); hospital outpatient 90 (MAI 3, Clinical: Data); DME supplier 120 (MAI 3, Published Contractor Policy) units per day in the 2026 Q4 MUE tables. The DME supplier MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for A5057 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services903 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital903 Date of Service Edit: ClinicalClinical: Data
DME supplier1203 Date of Service Edit: ClinicalPublished Contractor Policy

The MUE lookup for A5057 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists A5057 in v323r0.

A5057 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check A5057 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for A5057

1 active Local Coverage Determination and 0 billing and coding articles list A5057. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Denials to expect on A5057

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists A5057

CARC 151 · N362

units of A5057 exceed the DME supplier MUE of 120 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for A5057 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for A5057 depend on, with human review of each case, and QuickRCM carries claim readiness and the CARC 50, 151 and modifier denials these items draw.

See QuickAuth for requirement checksSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS A5057

What does HCPCS code A5057 describe?

"Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each" (short descriptor "1 pc ost pou w built-in conv"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 2012-01-01.

Is A5057 a CPT code?

It is not. A5057 belongs to the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for A5057?

The October 2026 DMEPOS fee schedule (category OS, ostomy, tracheostomy and urological items) sets A5057 at $13.68 in every contiguous state (floor $11.63, ceiling $13.68).

How many units of A5057 can be billed per day?

CMS caps A5057 at practitioner 90 (MAI 3, Clinical: Data); hospital outpatient 90 (MAI 3, Clinical: Data); DME supplier 120 (MAI 3, Published Contractor Policy) units per day in the 2026 Q4 MUE tables. For the DME supplier MUE (MAI 3), units above 120 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover A5057?

Coverage code D (special coverage instructions apply). 1 active LCD lists A5057: L33828 (Ostomy Supplies).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.