A5131 — Appliance cleaner, incontinence and ostomy appliances, per 16 oz.
HCPCS Level II A-code · short descriptor: “Appliance cleaner”
- 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
- 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.
A5131 Medicare fee schedule (April 2026)
Base (no modifier) Ostomy, tracheostomy & urological supplies
Medicare allowable ranges from $19.20 to $72.12 depending on state and rural status.
Former-CBA payment limits: ceiling $22.59 · floor $19.20
| State | Non-rural | Rural |
|---|---|---|
| AK | $23.75 | — |
| AL | $22.59 | — |
| AR | $19.20 | — |
| AZ | $19.20 | — |
| CA | $22.59 | — |
| CO | $22.59 | — |
| CT | $22.59 | — |
| DC | $22.59 | — |
| DE | $22.59 | — |
| FL | $19.20 | — |
| GA | $22.59 | — |
| HI | $25.40 | — |
| IA | $19.20 | — |
| ID | $19.20 | — |
| IL | $20.62 | — |
| IN | $19.96 | — |
| KS | $19.20 | — |
| KY | $22.57 | — |
| LA | $19.20 | — |
| MA | $22.59 | — |
| MD | $22.59 | — |
| ME | $22.59 | — |
| MI | $19.20 | — |
| MN | $19.20 | — |
| MO | $22.59 | — |
| MS | $22.59 | — |
| MT | $20.88 | — |
| NC | $20.60 | — |
| ND | $22.59 | — |
| NE | $19.20 | — |
| NH | $22.59 | — |
| NJ | $22.59 | — |
| NM | $22.59 | — |
| NV | $19.65 | — |
| NY | $22.59 | — |
| OH | $19.20 | — |
| OK | $22.59 | — |
| OR | $19.20 | — |
| PA | $22.59 | — |
| PR | $72.12 | — |
| RI | $22.59 | — |
| SC | $19.20 | — |
| SD | $22.59 | — |
| TN | $20.61 | — |
| TX | $22.59 | — |
| UT | $22.59 | — |
| VA | $19.20 | — |
| VI | $22.59 | — |
| VT | $22.59 | — |
| WA | $19.70 | — |
| WI | $19.20 | — |
| WV | $19.20 | — |
| WY | $22.59 | — |
Common denial codes to watch
Related A-codes
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