Browse HCPCS Level II 2020 Edition

A5102 - A5200  Additional Incontinence and Ostomy supplies

A5102 Bedside drainage bottle with or without tubing, rigid or expandable, each short Bedside drain btl w/wo tube RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 3 Date of Service Edit: Clinical Clinical: Data DME 1.0 3 Date of Service Edit: Clinical Published Contractor Policy

A5105 Urinary suspensory with leg bag, with or without tube, each short Urinary suspensory RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 3 Date of Service Edit: Clinical Clinical: Data DME 4.0 3 Date of Service Edit: Clinical Clinical: Data

A5112 Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each short Urinary leg bag RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 3 Date of Service Edit: Clinical Clinical: CMS Workgroup DME 3.0 3 Date of Service Edit: Clinical Published Contractor Policy

A5113 Leg strap; latex, replacement only, per set short Latex leg strap RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy DME 3.0 3 Date of Service Edit: Clinical Clinical: Data

A5114 Leg strap; foam or fabric, replacement only, per set short Foam/fabric leg strap RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 0.0 3 Date of Service Edit: Clinical CMS Policy DME 3.0 3 Date of Service Edit: Clinical Clinical: CMS Workgroup

A5120 Skin barrier, wipes or swabs, each short Skin barrier, wipe or swab RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 150.0 3 Date of Service Edit: Clinical Published Contractor Policy OPH 150.0 3 Date of Service Edit: Clinical Published Contractor Policy DME 450.0 3 Date of Service Edit: Clinical Published Contractor Policy

A5121 Skin barrier; solid, 6 x 6 or equivalent, each short Solid skin barrier 6x6 RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 3 Date of Service Edit: Clinical Clinical: Data

A5122 Skin barrier; solid, 8 x 8 or equivalent, each short Solid skin barrier 8x8 RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 3 Date of Service Edit: Clinical Clinical: Data

A5126 Adhesive or non-adhesive; disk or foam pad short Disk/foam pad +or- adhesive RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 2.0 3 Date of Service Edit: Clinical Clinical: CMS Workgroup

A5131 Appliance cleaner, incontinence and ostomy appliances, per 16 oz. short Appliance cleaner RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 1.0 3 Date of Service Edit: Clinical Clinical: CMS Workgroup DME 3.0 3 Date of Service Edit: Clinical Published Contractor Policy

A5200 Percutaneous catheter/tube anchoring device, adhesive skin attachment short Percutaneous catheter anchor RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 2.0 3 Date of Service Edit: Clinical Clinical: Data OPH 2.0 3 Date of Service Edit: Clinical Clinical: Data