A5055 — Stoma cap
HCPCS Level II A-code
- Code system
- HCPCS Level II
- Family
- A — Medical & surgical supplies, ambulance
- Medicare coverage status
- Special coverage instructions apply
- DMEPOS payment category
- Ostomy, tracheostomy & urological supplies
- Prior authorization
- Not on Medicare required-PA list
- Status
- Active (April 2026 HCPCS)
Prior authorization
Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
A5055 Medicare fee schedule (April 2026)
Base (no modifier) Ostomy, tracheostomy & urological supplies
Medicare allowable ranges from $1.74 to $2.19 depending on state and rural status.
Former-CBA payment limits: ceiling $2.05 · floor $1.74
| State | Non-rural | Rural |
|---|---|---|
| AK | $1.99 | — |
| AL | $2.05 | — |
| AR | $2.05 | — |
| AZ | $1.99 | — |
| CA | $1.90 | — |
| CO | $2.01 | — |
| CT | $2.02 | — |
| DC | $2.05 | — |
| DE | $2.02 | — |
| FL | $2.05 | — |
| GA | $2.05 | — |
| HI | $2.09 | — |
| IA | $2.05 | — |
| ID | $1.99 | — |
| IL | $2.05 | — |
| IN | $2.05 | — |
| KS | $2.02 | — |
| KY | $2.05 | — |
| LA | $2.05 | — |
| MA | $2.05 | — |
| MD | $2.05 | — |
| ME | $2.05 | — |
| MI | $2.05 | — |
| MN | $2.05 | — |
| MO | $2.05 | — |
| MS | $1.87 | — |
| MT | $1.99 | — |
| NC | $1.76 | — |
| ND | $2.02 | — |
| NE | $2.02 | — |
| NH | $2.05 | — |
| NJ | $2.02 | — |
| NM | $2.05 | — |
| NV | $2.05 | — |
| NY | $2.02 | — |
| OH | $1.88 | — |
| OK | $2.05 | — |
| OR | $2.05 | — |
| PA | $2.02 | — |
| PR | $2.19 | — |
| RI | $2.02 | — |
| SC | $1.90 | — |
| SD | $2.02 | — |
| TN | $1.74 | — |
| TX | $1.99 | — |
| UT | $1.85 | — |
| VA | $2.05 | — |
| VI | $2.02 | — |
| VT | $2.05 | — |
| WA | $2.05 | — |
| WI | $2.05 | — |
| WV | $1.88 | — |
| WY | $2.02 | — |
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026.
Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%.
A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area
adjustments and non-continental rates can differ — verify with your DME MAC.
Common denial codes to watch
Related A-codes
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