A5056 — Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each

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 statusX

Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.

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 A5056 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

90 units

MAI 3 — Date of Service Edit: Clinical · Clinical: Data

outpatient

90 units

MAI 3 — Date of Service Edit: Clinical · Clinical: Data

DME supplier

120 units

MAI 3 — Date of Service Edit: Clinical · Published Contractor Policy

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.