2024 HCPCS Code A5057

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 Coverage Code	D - Special coverage instructions apply
HCPCS Action Code	N - No maintenance for this code
HCPCS Action Effective Date	January 01, 2012
HCPCS Code Added Date	January 01, 2012
HCPCS Pricing Indicator Code	37 - Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)
HCPCS Multiple Pricing Indicator Code	A - Not applicable as HCPCS priced under one methodology
HCPCS Coverage Issues Manual Reference Section Number
HCPCS Type Of Service Code	P - Lump sum purchase of DME, prosthetics, orthotics
HCPCS Anesthesia Base Unit Quantity	0