HCPCS Code A5057

Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each
Code effective Jan 01, 2012

HCPCS Section
Transportation Services Including Ambulance, Medical & Surgical Supplies

A5057 is a valid 2026 HCPCS code meaning Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each or (1 pc ost pou w built-in conv) for short. HCPCS A5057 has been effective since 01/01/2012 and applies to Lump sum purchase of DME, prosthetics, orthotics.

HCPCS Code Details - A5057

HCPCS Level II Code
Section A - Transportation Services Including Ambulance, Medical & Surgical Supplies
HCPCS Code A5057
Description

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

Short description:
1 pc ost pou w built-in conv

HCPCS Pricing indicator 37 - Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)
Multiple pricing indicator A - Not applicable as HCPCS priced under one methodology
Coverage code D - Special coverage instructions apply
BETOS2 code D1F - Prosthetic/Orthotic devices
HCPCS Action code N - No maintenance for this code
Type of service P - Lump sum purchase of DME, prosthetics, orthotics
Effective date Effective Jan 01, 2012
Date added Added Jan 01, 2012

See also

  • HCPCS A4375 · Ostomy pouch, drainable, with faceplate attached, plastic, each

  • HCPCS A4376 · Ostomy pouch, drainable, with faceplate attached, rubber, each

  • HCPCS A4377 · Ostomy pouch, drainable, for use on faceplate, plastic, each

  • HCPCS A4378 · Ostomy pouch, drainable, for use on faceplate, rubber, each

  • HCPCS A4388 · Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each

  • HCPCS A4389 · Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each

  • HCPCS A4390 · Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each

  • HCPCS A4412 · Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each

  • HCPCS A4413 · Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each

  • HCPCS A4424 · Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each

  • HCPCS A4435 · Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each

  • HCPCS A5056 · Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each

  • HCPCS A5061 · Ostomy pouch, drainable; with barrier attached, (1 piece), each

1 Two-digit numeric codes are Level I code modifiers copyrighted© by the American Medical Association's Current Procedural Terminology (CPT).

2 BETOS stands for “Berenson-Eggers Type Of Service”

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 6/23/2026

CPT® is a registered trademark of the American Medical Association (AMA). All rights reserved.