Medicare Allowables
Below is a list of current Medicare allowable for ostomy supplies, urological supplies and wound care supplies . If you have any questions, reach out to our team today! We’re happy to help.
Ostomy Allowables
CODES | MEDICARE ALLOWABLE UNITS | MAX ALLOWABLES PER MONTH |
POUCHES (CODES VARY) | 60 UNITS CLOSED POUCH 20 UNITS DRAINABLE POUCH
| 60 EA FOR CLOSED POUCHES 20 EA DRAINABLE BAGS |
WAFERS (CODES VARY) | 20 UNITS | 20 WAFERS PER MONTH |
A5120 SKIN PREP WIPES | 25 UNITS | 25 EA PER MONTH |
A4456 ADHESIVE REMOVER | 50 UNITS | 1 BX/50 EA PER MONTH |
A4367 OSTOMY BELT | 1 UNIT | 1 EA PER MONTH |
A4450 TAPE | 80 UNITS | 2 ROLLS PER MONTH |
A4406 PASTE | 4 UNITS | 2 EA TUBES PER MONTH |
A4385/A4362/A5121 (SEALS, RINGS, BARRIER STRIPS) | 20 UNITS A5121 - 60 UNITS | 20 EA PER MONTH |
A5055 STOMA CAPS | 30 UNITS | 30 PER MONTH |
Urological Allowables
CODES | MEDICARE ALLOWABLE UNITS | MAX ALLOWABLES PER MONTH |
A4338 (INDWELLING/FOLEY CATHETER) | 1 UNIT | 1 EA PER MONTH |
A4340 INDWELLING/FOLEY CATHETER COUDE TIP*** | 1 UNIT | 1 EA PER MONTH |
A4310 INSERTION TRAY | 1 UNIT | 1 EA PER MONTH |
A4331 EXTENSION TUBE ONLY FOR PATIENTS USING A5112 | 1 UNIT | 1 EA PER MONTH |
A4349 MALE EXTERNAL CATHETER | 35 UNIT | 35 EA PER MONTH |
A4351 INTERMITTENT, STRAIGHT CATHETER | 200 UNITS | 200 EA MAX/BASED ON FREQUENCY OF CATHETERIZATION ORDERED |
A4352 INTERMITTENT, STRAIGHT CATHETER COUDE | 200 UNITS | 200 EA MAX/BASED ON FREQUENCY OF CATHETERIZATION ORDERED |
A4353 INTERMITTENT CATHETER KIT CLOSED SYSTEM*** | 200 UNITS | 200 EA MAX/BASED ON FREQUENCY OF CATHETERIZATION ORDERED |
A4357 URINARY DRAINAGE BAG | 2 UNITS | 2 EA PER MONTH |
A4358 URINARY LEG BAG WITH OR WITHOUT EXTENSION TUBE AND STRAPS | 2 UNITS | 2 EA PER MONTH |
A5112 REUSABLE URINARY LEG BAG | 1 UNIT | 1 PER MONTH ONLY |
A4402 LUBRICANT 2OZ | 2 UNITS | 2 EA PER MONTH |
A4332 LUBRICANT PACKS | EQUIVALENT TO FREQUENCY OF CATHETERIZATION | BASED ON FREQUENCY OF CATHETERIZATION |
Wound Care Allowables
PLEASE NOTE: AMOUNT SENT IS BASED ON CHANGING FREQUENCY, NUMBER OF WOUNDS, AND DOCTORS ORDERS.
CODES | MEDICARE ALLOWABLE | MAX ALLOWABLES PER MONTH |
A6021 COLLAGEN 2X2 OR 4X4 | BASED ON FREQUENCY OF WOUND CHANGE AND NUMBER OF WOUNDS | BASED ON FREQUENCY OF WOUND CHANGE AND NUMBER OF WOUNDS |
A6021 COLLAGEN WITH SILVER | BASED ON FREQUENCY OF WOUND CHANGE AND | BASED ON FREQUENCY OF WOUND CHANGE AND NUMBER OF WOUNDS |
A6197 CALCIUM ALGINATE 2X2 OR 4X4 | 1 UNIT PER DAY | 1 PER DAY PER WOUND/BASED ON FREQUENCY OF WOUND CHANGE |
A6197 CALCIUM ALGINATE WITH SILVER 2X2 OR 4X4 | 1 UNIT PER DAY | 1 PER DAY PER WOUND/BASED ON FREQUENCY OF WOUND CHANGE |
A6248 HYDROGEL TUBE | 3 UNITS MAX MONTHLY | 3 UNITS MAX/3OZ A MONTH PER WOUND |
A6231 HYDROGEL PAD 4X4 ONLY | 1 UNIT PER | 1 PER DAY PER WOUND/BASED ON FREQUENCY OF WOUND CHANGE |
A6248 HYDROGEL WITH SILVER 4X4 ONLY | 3 UNITS MAX | 3 UNITS MAX/3OZ A MONTH PER WOUND |
A6234 HYDROCOLLOIDS THIN/THICK 4X4 OR 6X6 | 3 UNITS PER WEEK | 3 PER WEEK PER WOUND |
A6234 HYDROCOLLOIDS WITH BORDER 4X4 OR 6X6 | 3 UNITS PER WEEK | 3 PER WEEK PER WOUND |
A6402 GAUZE PAD STERILE 2X2, 4X4 | 3 UNITS PER | 3 PER DAY PER WOUND/BASED ON FREQUENCY OF WOUND CHANGE |
A6216 GAUZE N/S 2X2 OR 4X4 | 200 UNITS MAX | 200 UNITS MAX = 1 LOAF PER MONTH |
A6223 XEROFORM 5X9 A6222 XEROFORM 4X4 | 1 UNIT PER DAY | 1 PER DAY PER WOUND/BASED ON FREQUENCY OF WOUND CHANGE |
A6223 VASELINE GAUZE 3X9 | 1 UNIT PER DAY | 1 PER DAY PER WOUND/BASED ON FREQUENCY OF WOUND CHANGE |
A6222 ADAPTIC 3X3, A6223 ADAPTIC 3X8 | 1 UNIT PER DAY | 1 PER DAY PER WOUND/BASED ON FREQUENCY OF WOUND CHANGE |
A4216 NORMAL SALINE 100ML | 70 UNITS MAX PER MONTH | 70 UNITS MAX PER MONTH = 7 BTLS MONTHLY |
A6252 ABD PAD 5X9 A6253 ABD 8X10 | 1 UNIT PER DAY | 1 PER DAY PER WOUND/BASED ON FREQUENCY OF WOUND CHANGE |
A6402 NON ADHERENT PAD 3X4 ONLY | 1 UNIT PER DAY | 1 PER DAY PER WOUND/BASED ON FREQUENCY OF WOUND CHANGE |
A6212 FOAM DRESSING 4X4, 6X6 | 3 UNITS PER WEEK | 3 PER WEEK PER WOUND |
A6212 BORDERED FOAM 4X4, 6X6 | 3 UNITS PER WEEK | 3 PER WEEK PER WOUND |
A6447 KERLIX 4” PER ROLL ONLY | BASED ON FREQUENCY OF WOUND CHANGE AND NUMBER OF WOUNDS | BASED ON FREQUENCY OF WOUND CHANGE AND NUMBER OF WOUNDS |
A6446 SOFFORM 2”, 3” 4” | BASED ON FREQUENCY OF WOUND CHANGE AND NUMBER OF WOUNDS | BASED ON FREQUENCY OF WOUND CHANGE AND NUMBER OF WOUNDS |
A6454 COBAN 2”, 3” 4” |
20 UNITS = 4 ROLLS MONTHLY |
4 ROLLS MONTHLY/1 PER WEEK PER WOUND |
A6449 ELASTIC BANDAGE 2”, 3”, 4” | 20 UNITS = 4 ROLLS MONTHLY | 4 ROLLS MONTHLY/1 PER WEEK PER WOUND |
A4452 CLOTH TAPE 1”, 2”, 3” | 40 UNITS BIWEEKLY = 2 ROLLS | 2 ROLLS PER WOUND BIWEEKLY = BASED ON FREQUENCY OF WOUND CHANGE AND NUMBER OF WOUNDS |
A4452 MEFIX 2”, 4” | 176 UNITS BIWEEKLY = 2 ROLLS
| 2 ROLLS PER WOUND BIWEEKLY = BASED ON FREQUENCY OF WOUND CHANGE AND NUMBER OF WOUNDS |
A4450 PAPER TAPE 1”, 2”, 3” | 80 UNITS = 2 ROLLS | 2 ROLLS PER WOUND BIWEEKLY = BASED ON FREQUENCY OF WOUND CHANGE AND NUMBER OF WOUNDS |
