A5126 — Adhesive or non-adhesive; disk or foam pad
A5126 is a HCPCS Level II code for adhesive or non-adhesive; disk or foam pad. 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 A5126 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
- 2 units 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 A5126
- Long descriptor
- Adhesive or non-adhesive; disk or foam pad
- Short descriptor
- Disk/foam pad +or- adhesive
- 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 A5126
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A5126 is not quite right, the correct code is very often within a few positions of it.
- A5102Bedside drainage bottle with or without tubing, rigid or expandable, each
- A5105Urinary suspensory with leg bag, with or without tube, each
- A5112Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each
- A5113Leg strap; latex, replacement only, per set
- A5114Leg strap; foam or fabric, replacement only, per set
- A5120Skin barrier, wipes or swabs, each
- A5121Skin barrier; solid, 6 x 6 or equivalent, each
- A5122Skin barrier; solid, 8 x 8 or equivalent, each
- A5131Appliance cleaner, incontinence and ostomy appliances, per 16 oz.
- A5200Percutaneous catheter/tube anchoring device, adhesive skin attachment
- A5500For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe
- A5501For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe
- A5503For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe
- A5504For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe
- A5505For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe
- A5506For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe
Questions about A5126
What is HCPCS code A5126?
A5126 is a HCPCS Level II code for adhesive or non-adhesive; disk or foam pad. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A5126?
The CMS HCPCS file marks A5126 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 A5126 paid under the physician fee schedule?
A5126 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.