This section covers a wide variety of medical and surgical supplies, as well as some DME-related supplies and accessories. Medicare generally covers DME-related supplies, accessories, maintenance, and repair under the prosthetic devices provision.

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• A4890

  Contracts, repair and maintenance, for hemodialysis equipment

• A4911

  Drain bag/bottle, for dialysis, each

• A4913

  Miscellaneous dialysis supplies, not otherwise specified

• A4918

  Venous pressure clamp, for hemodialysis, each

• A4927

  Gloves, non-sterile, per 100

• A4928

  Surgical mask, per 20

• A4929

  Tourniquet for dialysis, each

• A4930

  Gloves, sterile, per pair

• A4931

  Oral thermometer, reusable, any type, each

• A4932

  Rectal thermometer, reusable, any type, each

• A5051

  Ostomy pouch, closed; with barrier attached (1 piece), each

• A5052

  Ostomy pouch, closed; without barrier attached (1 piece), each

• A5053

  Ostomy pouch, closed; for use on faceplate, each

• A5054

  Ostomy pouch, closed; for use on barrier with flange (2 piece), each

• A5055

  Stoma cap

• A5056

  Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each

• A5057

  Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each

• A5061

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

• A5062

  Ostomy pouch, drainable; without barrier attached (1 piece), each

• A5063

  Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each

• A5071

  Ostomy pouch, urinary; with barrier attached (1 piece), each

• A5072

  Ostomy pouch, urinary; without barrier attached (1 piece), each

• A5073

  Ostomy pouch, urinary; for use on barrier with flange (2 piece), each

• A5081

  Stoma plug or seal, any type

• A5082

  Continent device; catheter for continent stoma

• A5083

  Continent device, stoma absorptive cover for continent stoma

• A5093

  Ostomy accessory; convex insert

• A5102

  Bedside drainage bottle with or without tubing, rigid or expandable, each

• A5105

  Urinary suspensory with leg bag, with or without tube, each

• A5112

  Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each

• A5113

  Leg strap; latex, replacement only, per set

• A5114

  Leg strap; foam or fabric, replacement only, per set

• A5120

  Skin barrier, wipes or swabs, each

• A5121

  Skin barrier; solid, 6 x 6 or equivalent, each

• A5122

  Skin barrier; solid, 8 x 8 or equivalent, each

• A5126

  Adhesive or non-adhesive; disk or foam pad

• A5131

  Appliance cleaner, incontinence and ostomy appliances, per 16 oz.

• A5200

  Percutaneous catheter/tube anchoring device, adhesive skin attachment

• A5500

  For 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

• A5501

  For 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

• A5503

  For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe

• A5504

  For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe

• A5505

  For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe

• A5506

  For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe

• A5507

  For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe

• A5508

  For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe

• A5510

  For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoe

• A5512

  For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each

• A5513

  For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each

• A5514

  For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each

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HCPCS Level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association). — Updated 6/3/2026

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