A5061 — Ostomy pouch, drainable; with barrier attached, (1 piece), each

Medicare coverage: Carrier judgment

Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.

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 A5061 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

2 units

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.