HCPCS code A5057 — 1 pc ost pou w built-in conv. Status: Active. Effective Jan 1, 2012. Source: CMS HCPCS Level II.

A5057

Active

1 pc ost pou w built-in conv

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

Category: Transportation & Supplies
Section: A-codes: Transportation, Medical & Surgical Supplies
Effective: Jan 1, 2012
Code type: alphanumeric
OPPS Status: N — Items / services packaged into APC rates

MUE — Medically Unlikely Edits

Maximum units of A5057 Medicare will pay for one beneficiary on one date of service. Claims exceeding the MUE are denied or returned for review.

Service Type Max Units / Day
DME Supplier 120
Outpatient Hospital 90
Practitioner Services 90

Source: CMS Medicare NCCI Medically Unlikely Edits