# HCPCS A5052: Ostomy pouch, closed, without barrier attached, each

Medicare HCPCS A5052 pays $2.13 on average under the 2026 Q4 Medicare DMEPOS Fee Schedule (non-rural). State amounts run from $2.12 in Wyoming to $2.57 in Puerto Rico, a 21% spread.

Web page: https://www.med-reveal.com/rates/A5052-hcpcs-fee-schedule
Section: DME, Prosthetics, Orthotics and Supplies

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $2.13 |
| National facility | $2.13 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Puerto Rico | $2.57 | $2.57 |
| Alabama | $2.12 | $2.12 |
| Alaska | $2.12 | $2.12 |
| Arizona | $2.12 | $2.12 |
| Arkansas | $2.12 | $2.12 |
| California | $2.12 | $2.12 |
| Colorado | $2.12 | $2.12 |
| Connecticut | $2.12 | $2.12 |
| Delaware | $2.12 | $2.12 |
| District of Columbia | $2.12 | $2.12 |
| Florida | $2.12 | $2.12 |
| Georgia | $2.12 | $2.12 |
| Hawaii | $2.12 | $2.12 |
| Idaho | $2.12 | $2.12 |
| Illinois | $2.12 | $2.12 |
| Indiana | $2.12 | $2.12 |
| Iowa | $2.12 | $2.12 |
| Kansas | $2.12 | $2.12 |
| Kentucky | $2.12 | $2.12 |
| Louisiana | $2.12 | $2.12 |
| Maine | $2.12 | $2.12 |
| Maryland | $2.12 | $2.12 |
| Massachusetts | $2.12 | $2.12 |
| Michigan | $2.12 | $2.12 |
| Minnesota | $2.12 | $2.12 |
| Mississippi | $2.12 | $2.12 |
| Missouri | $2.12 | $2.12 |
| Montana | $2.12 | $2.12 |
| Nebraska | $2.12 | $2.12 |
| Nevada | $2.12 | $2.12 |
| New Hampshire | $2.12 | $2.12 |
| New Jersey | $2.12 | $2.12 |
| New Mexico | $2.12 | $2.12 |
| New York | $2.12 | $2.12 |
| North Carolina | $2.12 | $2.12 |
| North Dakota | $2.12 | $2.12 |
| Ohio | $2.12 | $2.12 |
| Oklahoma | $2.12 | $2.12 |
| Oregon | $2.12 | $2.12 |
| Pennsylvania | $2.12 | $2.12 |
| Rhode Island | $2.12 | $2.12 |
| South Carolina | $2.12 | $2.12 |
| South Dakota | $2.12 | $2.12 |
| Tennessee | $2.12 | $2.12 |
| Texas | $2.12 | $2.12 |
| Utah | $2.12 | $2.12 |
| Vermont | $2.12 | $2.12 |
| Virgin Islands | $2.12 | $2.12 |
| Virginia | $2.12 | $2.12 |
| Washington | $2.12 | $2.12 |
| West Virginia | $2.12 | $2.12 |
| Wisconsin | $2.12 | $2.12 |
| Wyoming | $2.12 | $2.12 |

## Related codes

- A4361: Ostomy faceplate — https://www.med-reveal.com/rates/A4361-hcpcs-fee-schedule
- A4362: Skin barrier, solid, 4x4 or equivalent, each — https://www.med-reveal.com/rates/A4362-hcpcs-fee-schedule
- A4363: Ostomy clamp, any type, replacement only — https://www.med-reveal.com/rates/A4363-hcpcs-fee-schedule
- A4367: Ostomy belt, each — https://www.med-reveal.com/rates/A4367-hcpcs-fee-schedule
- A4371: Ostomy skin barrier, powder, per oz — https://www.med-reveal.com/rates/A4371-hcpcs-fee-schedule
- A4375: Ostomy pouch, drainable, with faceplate attached, plastic, each — https://www.med-reveal.com/rates/A4375-hcpcs-fee-schedule
- A4383: Ostomy pouch, drainable, for use on barrier with flange, rubber, each — https://www.med-reveal.com/rates/A4383-hcpcs-fee-schedule
- A4396: Ostomy belt with peristomal hernia support — https://www.med-reveal.com/rates/A4396-hcpcs-fee-schedule

Commercial negotiated rates for A5052 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules