A5131 — Appliance cleaner, incontinence and ostomy appliances, per 16 oz.
A5131 is a HCPCS Level II code for appliance cleaner, incontinence and ostomy appliances, per 16 oz.. It belongs to the Transportation, Medical & Surgical Supplies, Administrative section. Whether Medicare pays it depends on the coverage rule below.
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 A5131 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
- DME supplier
- 3 units MAI 3 — Date of Service Edit: Clinical · Published Contractor Policy
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.
The CMS record for A5131
- Long descriptor
- Appliance cleaner, incontinence and ostomy appliances, per 16 oz.
- Short descriptor
- Appliance cleaner
- Added
- January 1, 1990
- BETOS
- D1F
- Pricing indicator
- 37 — DMEPOS
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Ostomy, tracheostomy and urological supplies. Price subject to floors and ceilings.
Codes adjacent to A5131
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A5131 is not quite right, the correct code is very often within a few positions of it.
- A5105Urinary suspensory with leg bag, with or without tube, each
- A5112Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each
- A5113Leg strap; latex, replacement only, per set
- A5114Leg strap; foam or fabric, replacement only, per set
- A5120Skin barrier, wipes or swabs, each
- A5121Skin barrier; solid, 6 x 6 or equivalent, each
- A5122Skin barrier; solid, 8 x 8 or equivalent, each
- A5126Adhesive or non-adhesive; disk or foam pad
- A5200Percutaneous catheter/tube anchoring device, adhesive skin attachment
- A5500For 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
- A5501For 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
- A5503For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe
- A5504For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe
- A5505For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe
- A5506For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe
- A5507For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe
Questions about A5131
What is HCPCS code A5131?
A5131 is a HCPCS Level II code for appliance cleaner, incontinence and ostomy appliances, per 16 oz.. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A5131?
The CMS HCPCS file marks A5131 as "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.
How is A5131 paid under the physician fee schedule?
A5131 carries PFS status code P. Bundled or excluded. No RVUs and no payment: either bundled into another service or paid under a different provision of the Act.