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A5120 — Skin barrier, wipes or swabs, each

HCPCS Level II A-code · short descriptor: “Skin barrier, wipe or swab”

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, Prosthetics & orthotics
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.

A5120 Medicare fee schedule (April 2026)

AU Ostomy, tracheostomy & urological supplies

Medicare allowable ranges from $0.14 to $0.38 depending on state and rural status.

Former-CBA payment limits: ceiling $0.35 · floor $0.30

StateNon-ruralRural
AK$0.36
AL$0.35
AR$0.31
AZ$0.31
CA$0.35
CO$0.33
CT$0.35
DC$0.35
DE$0.35
FL$0.35
GA$0.35
HI$0.38
IA$0.35
ID$0.35
IL$0.33
IN$0.31
KS$0.35
KY$0.31
LA$0.31
MA$0.35
MD$0.35
ME$0.35
MI$0.35
MN$0.35
MO$0.35
MS$0.33
MT$0.35
NC$0.33
ND$0.35
NE$0.35
NH$0.35
NJ$0.35
NM$0.33
NV$0.31
NY$0.35
OH$0.31
OK$0.33
OR$0.30
PA$0.35
PR$0.14
RI$0.35
SC$0.33
SD$0.35
TN$0.33
TX$0.35
UT$0.30
VA$0.30
VI$0.35
VT$0.35
WA$0.33
WI$0.35
WV$0.31
WY$0.35

AV Prosthetics & orthotics

Medicare allowable ranges from $0.16 to $0.39 depending on state and rural status.

Former-CBA payment limits: ceiling $0.40 · floor $0.30

StateNon-ruralRural
AK$0.35
AL$0.33
AR$0.33
AZ$0.33
CA$0.33
CO$0.32
CT$0.39
DC$0.32
DE$0.32
FL$0.33
GA$0.33
HI$0.36
IA$0.33
ID$0.30
IL$0.33
IN$0.33
KS$0.33
KY$0.33
LA$0.33
MA$0.39
MD$0.32
ME$0.39
MI$0.33
MN$0.33
MO$0.33
MS$0.33
MT$0.32
NC$0.33
ND$0.32
NE$0.33
NH$0.39
NJ$0.33
NM$0.33
NV$0.33
NY$0.33
OH$0.33
OK$0.33
OR$0.30
PA$0.32
PR$0.16
RI$0.39
SC$0.33
SD$0.32
TN$0.33
TX$0.33
UT$0.32
VA$0.32
VI$0.33
VT$0.39
WA$0.30
WI$0.33
WV$0.32
WY$0.32
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.

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