MyMedi-AI

A5061 — Ostomy pouch, drainable; with barrier attached, (1 piece), each

HCPCS Level II A-code · short descriptor: “Pouch drainable w barrier at”

Code system
HCPCS Level II
Family
A — Medical & surgical supplies, ambulance
Medicare coverage status
Carrier judgment — coverage decided by the DME MAC
DMEPOS payment category
Ostomy, tracheostomy & urological supplies
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required 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.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

Not on the F2F/WOPD list (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

A5061 Medicare fee schedule (April 2026)

Base (no modifier) Ostomy, tracheostomy & urological supplies

Medicare allowable ranges from $5.04 to $6.03 depending on state and rural status.

Former-CBA payment limits: ceiling $5.04 · floor $4.28

StateNon-ruralRural
AK$5.04
AL$5.04
AR$5.04
AZ$5.04
CA$5.04
CO$5.04
CT$5.04
DC$5.04
DE$5.04
FL$5.04
GA$5.04
HI$5.04
IA$5.04
ID$5.04
IL$5.04
IN$5.04
KS$5.04
KY$5.04
LA$5.04
MA$5.04
MD$5.04
ME$5.04
MI$5.04
MN$5.04
MO$5.04
MS$5.04
MT$5.04
NC$5.04
ND$5.04
NE$5.04
NH$5.04
NJ$5.04
NM$5.04
NV$5.04
NY$5.04
OH$5.04
OK$5.04
OR$5.04
PA$5.04
PR$6.03
RI$5.04
SC$5.04
SD$5.04
TN$5.04
TX$5.04
UT$5.04
VA$5.04
VI$5.04
VT$5.04
WA$5.04
WI$5.04
WV$5.04
WY$5.04
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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