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See a sample rate comparisonHCPCS A5081 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Stoma plug or seal, any type
| Key Fact | Detail |
|---|---|
| Service Type | Medical And Surgical Supplies Ostomy Pouches and Supplies |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for A5081 |
National average reimbursement for HCPCS A5081 by major payers:
$3.41
$2.39
$2.91
$5.52
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HCPCS A5081
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$8.47Published rateUnion County Hospital Authority, Union General Hospital
Union County Hospital Authority
$3.26Published rateStephens County Anesthesia Services,LLC
Stephens County Anesthesia Servicesllc
$2.66Published rateHospital Authority Of Liberty County, Liberty Regional Medical Center
$1.87Published rateGrady Memorial Hospital Corporation, Grady Health Systems
Grady Memorial Hospital Corporation
$1.66Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS A5081 vs. Other Ostomy Pouches and Supplies Codes
The HCPCS A5081 code is part of the Medical And Surgical Supplies services used for Ostomy Pouches and Supplies. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS A5081 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| A5073-HCPCS | Low | Ostomy pouch, urinary; for use on barrier with flange (2-piece), each |
| A5081-HCPCS | Low | Stoma plug or seal, any type |
| A5082-HCPCS | Low | Continent device; catheter for continent stoma |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS A5081. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the A5081 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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