`A5105` Urinary suspensory

Urinary suspensory with leg bag, with or without tube, each

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 1 units per day (clinical), rationale: Clinical: Data
DME supplier: max 4 units per day (clinical), rationale: Clinical: Data

Medicare pricing for A5105

DMEPOS fee schedule, July 2026 (DME26-C)

no modifier, ostomy, tracheostomy and urological (OS): non-rural $49.39 to $58.11 in the contiguous states; $28.84 to $91.13 in AK, HI, PR and VI; ceiling $58.11, floor $49.39

Physician Fee Schedule (CY 2026, RVU26D)

Status P: bundled or excluded, no separate PFS payment.

Payer policies and prior authorization for A5105

Payer coverage policies that name A5105

A5105 appears in 1 coverage policy from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Urological Supplies (0533)	covered if criteria are met	Jul 30, 2026	payer document

Medicaid fee-for-service

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

AZ: $69.35 (dme), effective Oct 1, 2026
CO: $38.90 (chp_plus, non-facility), effective Jul 1, 2026
FL: $15.45 (dme), effective Jul 1, 2026
IL: $38.76 (dme), effective Jan 1, 2026
IN: $27.42 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2014
KY: $33.88 (dme), effective Jan 1, 2026
LA: $24.00 (dme), effective Jul 1, 2012
MA: $40.20 (dme_rates), effective Mar 1, 2026
MD: $49.39 (dme), effective Apr 1, 2026
ND: $0.00 (dme), effective Aug 1, 2026
NE: $43.21 (dme), effective Jul 1, 2026
NY: $43.19 (dme), effective Jul 1, 2026
OH: $40.32 (dme), effective Jul 1, 2002
OK: $54.50 (dme), effective Jan 1, 2026
TX: $34.23 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective Jul 1, 1997
VA: $44.45 (dme), effective Dec 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $43.67 (medical_equipment_supplies), effective Jul 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.

A5105 Urinary suspensory