A5054 — Ostomy pouch, closed; for use on barrier with flange (2 piece), each

Medicare coverage: Special coverage instructions apply

There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.

From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.

Physician fee schedule statusP

Bundled or excluded. No RVUs and no payment: either bundled into another service or paid under a different provision of the Act.

Global period: XXX

Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.

Medically Unlikely Edits — units per day

The most units of A5054 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.

practitioner

0 — never payable

MAI 3 — Date of Service Edit: Clinical · CMS Policy

outpatient

1 unit

MAI 3 — Date of Service Edit: Clinical · Clinical: CMS Workgroup

The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.