A5055 — Stoma cap
A5055 is a HCPCS Level II code for stoma cap. It belongs to the Transportation, Medical & Surgical Supplies, Administrative section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusP
Bundled or excluded. No RVUs and no payment: either bundled into another service or paid under a different provision of the Act.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of A5055 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 1 unit MAI 3 — Date of Service Edit: Clinical · Clinical: CMS Workgroup
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for A5055
- Long descriptor
- Stoma cap
- Short descriptor
- Stoma cap
- Added
- January 1, 1990
- BETOS
- D1F
- Pricing indicator
- 37 — DMEPOS
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Ostomy, tracheostomy and urological supplies. Price subject to floors and ceilings.
Codes adjacent to A5055
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A5055 is not quite right, the correct code is very often within a few positions of it.
- A4929Tourniquet for dialysis, each
- A4930Gloves, sterile, per pair
- A4931Oral thermometer, reusable, any type, each
- A4932Rectal thermometer, reusable, any type, each
- A5051Ostomy pouch, closed; with barrier attached (1 piece), each
- A5052Ostomy pouch, closed; without barrier attached (1 piece), each
- A5053Ostomy pouch, closed; for use on faceplate, each
- A5054Ostomy pouch, closed; for use on barrier with flange (2 piece), each
- A5056Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each
- A5057Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each
- A5061Ostomy pouch, drainable; with barrier attached, (1 piece), each
- A5062Ostomy pouch, drainable; without barrier attached (1 piece), each
- A5063Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each
- A5071Ostomy pouch, urinary; with barrier attached (1 piece), each
- A5072Ostomy pouch, urinary; without barrier attached (1 piece), each
- A5073Ostomy pouch, urinary; for use on barrier with flange (2 piece), each
Questions about A5055
What is HCPCS code A5055?
A5055 is a HCPCS Level II code for stoma cap. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A5055?
The CMS HCPCS file marks A5055 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is A5055 paid under the physician fee schedule?
A5055 carries PFS status code P. Bundled or excluded. No RVUs and no payment: either bundled into another service or paid under a different provision of the Act.