`A5083` Stoma absorptive cover

Continent device, stoma absorptive cover for continent stoma

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 5 units per day (clinical), rationale: Clinical: CMS Workgroup
Outpatient hospital: max 5 units per day (clinical), rationale: Clinical: CMS Workgroup

Medicare pricing for A5083

DMEPOS fee schedule, July 2026 (DME26-C)

no modifier, ostomy, tracheostomy and urological (OS): non-rural $0.92 in the contiguous states; $0.92 to $1.07 in AK, HI, PR and VI; ceiling $0.92, floor $0.78

Physician Fee Schedule (CY 2026, RVU26D)

Status X: statutory exclusion, not paid under the PFS.

Payer policies and prior authorization for A5083

Payer coverage policies that name A5083

A5083 appears in 1 coverage policy from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Ostomy Supplies (0906)	covered if criteria are met	Dec 22, 2025	payer document

Medicaid fee-for-service

Prior authorization required or conditional in KY, MA, NY, OH, VA, WV.

AZ: $0.99 (dme), effective Oct 1, 2026
CO: $0.70 (chp_plus, non-facility), effective Jul 1, 2026
IN: $0.77 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KS: $0.74 (default), effective Jul 1, 2026
KY: $0.50 (dme), effective Jan 1, 2026
MA: $0.75 (dme_rates), effective Mar 1, 2026
MS: $0.74 (comprehensive), effective Jul 1, 2026
NE: $0.80 (dme), effective Jul 1, 2026
NY: $0.23 (dme), effective Jul 1, 2026
OH: $0.72 (dme), effective Jan 1, 2026
OK: $0.92 (dme), effective Jan 1, 2026
TX: $0.63 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective Jan 1, 2009
VA: $0.83 (dme), effective Dec 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

A5083 Stoma absorptive cover