Does Medicare Cover Ostomy Supplies?

Ostomy supplies are covered by Medicare so long as your doctor writes a prescription for these items, and you receive them from a medical supplier that accepts Medicare. You will owe 20 percent of the cost for ostomy supplies.

Understanding Medicare’s Coverage of Ostomy Supplies

Medicare covers ostomy supplies if you have a surgically created opening, or stoma, to divert urine or stool to outside your body.

These medically necessary supplies are covered by Medicare if you’ve undergone certain surgeries, including a colostomy, ileostomy or urinary ostomy.

You must have a prescription, signed and dated by your doctor, on file with the supplier who provides your ostomy materials.

You can order ostomy supplies from large mail-order distributors and local durable medical equipment suppliers.

You generally can’t get ostomy supplies from a local drugstore or retail pharmacy.

Cost of Ostomy Supplies

Ostomy supplies are covered by Medicare Part B as durable medical equipment. Specifically, these items are considered prosthetics because they replace a body organ or organ function.

You will owe 20 percent of the Medicare-approved amount for these supplies. Medicare pays the other 80 percent.

The Part B deductible — $203 in 2021 — also applies.

You may pay less for your ostomy supplies if you have supplemental insurance, such as Medicaid or a Medigap policy.

Medicare Advantage plans, which are administered by private insurers that contract with the federal government, must provide the same basic coverage as Original Medicare.

However, if you’re enrolled in a Medicare Advantage plan, there may be additional benefits or criteria you must follow to order your supplies.

Make sure to contact your Medicare Advantage plan’s customer service department to learn about such details before ordering your supplies.

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How Many Ostomy Supplies Can You Receive with Medicare?

The list of covered Medicare ostomy supplies is long.

The quantity and kind of supplies you need depends on the type of ostomy surgery you undergo.

The U.S. Centers for Medicare & Medicaid Services, or CMS, has determined standard quantities of ostomy supplies each beneficiary can receive.

Medicare may cover more items if your doctor clearly documents a need for additional supplies in your medical record.

Otherwise, Medicare may deny excess quantities If adequate documentation is not provided when requested.

The table below shows the maximum number of items typically considered medically necessary for certain common ostomy products. This is not an exhaustive list.

Ostomy Supplies Covered by Medicare, By Type and Quantity
CodeDescriptionUsual Medicare Maximum Quantities
A4357Bedside drainage bag 2 per month
A4362 Solid skin barrier 4x4 inches20 per month
A4367Ostomy belt1 per month
A4368Ostomy pouch filter, any typeNo maximum listed
A4369Skin barrier, liquid or spray, per ounce 2 ounces per month
A4371Skin barrier, powder, per ounce 10 ounces every 6 months
A5102Bedside drainage bottle with or without tubing, rigid or expandableNo maximum listed
A4388Ostomy drainable pouch with extended wear barrier No maximum listed
A4389Ostomy drainable pouch with barrier, convexNo maximum listed
A4394Ostomy pouch liquid deodorant 8 ounces per month
A5120Skin barrier wipes or swabs150 each, every 6 months
A5073Urinary pouch for use on barrier with flange, two-piece20 for each piece every month
A5057Ostomy drainable pouch with extended wear barrier, convex, filter, one-piece 40 per month
A4396Support beltNo maximum listed
A4404Ostomy ring 10 per month
A4405Ostomy paste (non-pectin based) 4 ounces per month
A4406Ostomy paste (pectin based)4 ounces per month
A5071Urinary pouch with barrier 20 per month
A5063Ostomy drainable pouch with flange, non-filter 20 per month
A5061Ostomy drainable pouch with barrier attached; one piece20 per month
A5056Ostomy drainable pouch with extended wear barrier, filter, one-piece 40 per month
A4407Skin barrier with flange, extended wear, convex (4x4 inches or smaller) No maximum listed
A4409Skin barrier with flange, extended wear (4x4 inches or smaller)No maximum listed
A5055Stoma cap 31 per month
A4412HOPO w filter > 750MLNo maximum listed
A4413HOPO w filter > 750MLNo maximum listed
A4414Skin barrier with flange, standard wear (4x4 inches or smaller)20 per month
A4415Ostomy standard wear skin barrier greater than 4x4 inches 20 per month
A4416Ostomy closed end pouch with filter 60 per month
A4417Ostomy closed end pouch with barrier, convex, filter, one-piece 60 per month
A4419Ostomy closed end pouch with filter on non-locking system 60 per month
A4423Ostomy closed end pouch for locking system, with filter60 per month
A4424Ostomy drainable pouch with barrier, filter, one-piece20 per month
A4433Ostomy urinary pouch for locking system20 per month
A4425Ostomy drainable pouch for non-locking system, with filter20 per month
A4427Ostomy drainable pouch for locking system, with filter 20 per month

In some situations, Medicare may restrict coverage for the type of ostomy supplies you can order.

Restrictions on Ostomy Supplies
  • If a liquid barrier is necessary, you can use either liquid/spray (A4369) or individual wipes/swabs (A5120), but not both.
  • If you have continent stomas, you can use the following: Stoma cap (A5055), stoma plug (A5081), stoma absorptive cover (A5083) or gauze pads (A6216). However, Medicare doesn’t consider the use of more than one of these types of supplies reasonable and necessary on a given day.
  • If you have urinary ostomies, you can use either a bag (A4357) or bottle (A5102) for drainage at night, but Medicare won’t cover both.

What if Medicare Denies My Ostomy Supply Claim?

Getting the medically necessary ostomy products you need can be tricky unless you follow certain Medicare rules and procedures.

Did You Know?
In 2019, nearly 30 percent of Original Medicare ostomy supply claims were improperly billed to Medicare, resulting in more than $65.5 million in improper billing.

When you are being discharged from the hospital to your home following ostomy surgery, your doctor should send the prescription for your supplies to a supply distributor approved by Medicare.

This prescription will include your list of ostomy supplies, amount and manufacturer reference numbers.

Similarly, if you are discharged home with home care, the home health care agency should be provided with this information from your doctor.

Keep in mind that home care agencies reimbursed by Medicare often have ostomy supply costs bundled into the payment for home care.

How to Prevent Medicare Denials of Ostomy Supplies
Have Your Doctor Write a Standard Written Order
A standard written order contains basic information like your name and your doctor’s name, as well as a description of the items ordered and the quantity to be dispensed. Your health care professional must share the standard written order with the supplier before they submit a claim.
Get Ostomy Supplies Added to Your Medical Record
Your health care professional should document the medical need for your ostomy supplies around the time he or she writes your first prescription. So long as you continue to need these products and meet eligibility criteria, there’s no need for further documentation unless your needs change in the future.
Make Sure Your Ostomy Supplies are Properly Coded
Health care professionals must correctly code your items and follow guidelines found in the CMS Healthcare Common Procedure Coding System, or similar publications.
Proof of Delivery
Medicare requires suppliers to maintain proof of delivery documentation. If a Medicare contractor asks for proof of delivery documentation, your supplier must make it available.

If Medicare denies your claim for ostomy supplies, you can file an appeal.

It may be helpful to review the denial with a health care professional who’s familiar with ostomies prior to filing an appeal. He or she might be able to identify the problem and provide a solution.

You can also call Medicare at 1-800-633-4227 for more information about why your claim was denied, and if needed, assistance with filing an appeal.

Last Modified: September 9, 2021

6 Cited Research Articles

  1. Mueller, S. (2021, March). Ostomy Supplies: How You Can Help Your Patients Solve the Puzzle. Retrieved from https://www.o-wm.com/article/ostomy-supplies-how-you-can-help-your-patients-solve-puzzle
  2. Centers for Medicare & Medicaid Services. (2020, August). Provider Compliance Tips for Ostomy Supplies. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ProviderComplianceTipsforOstomySupplies-ICN909480.pdf
  3. Centers for Medicare & Medicaid Services. (n.d.). Local Coverage Determination (LCD): Ostomy Supplies (L33828). Retrieved from https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33828&ContrId=389
  4. Centers for Medicare & Medicaid Services. (n.d.). Medicare Coverage of Durable Medical Equipment & Other Devices. Retrieved from https://www.medicare.gov/Pubs/pdf/11045-Medicare-Coverage-of-DME.PDF
  5. Coloplast. (n.d.). General Medicare guidelines for ostomy care. Retrieved from https://www.coloplast.us/Global/US/Ostomy/Professional/Wellness%20Articles/Reimbursement.pdf
  6. Medicare.gov. (n.d.). Ostomy supplies. Retrieved from https://www.medicare.gov/coverage/ostomy-supplies