Medicare Part B and ostomy supplies: a plain-English guide

How Original Medicare (Part B) covers ostomy supplies, and the usual quantities in the Medicare coverage policy. Last checked Nov 4, 2026.

Who is covered

• Medicare Part B covers ostomy supplies for people who have had a colostomy, ileostomy or urinary ostomy.^[4] The policy article says they are covered under the Prosthetic Device benefit.^[2]
• After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.^[4]
• Medicare.gov says Medicare covers the amount of supplies your doctor says you need, based on your condition.^[4]
• The policy article says supplies are covered for a person with a permanent impairment requiring an ostomy, and that “permanence” means a condition of long and indefinite duration.^[2]

How the “usual maximum” quantities work

The coverage policy (LCD L33828) has a table of the quantities of supplies that are usually reasonable and necessary, per month or per 6 months.^[1] It also says:

• The actual quantity a person needs may be more or less than the table. When more is needed, the reason must be documented in the medical record.^[1]
• A liquid or spray barrier (A4369) or barrier wipes (A5120) can be used, but not both.^[1]
• For urinary ostomies, a night drainage bag (A4357) or bottle (A5102) can be used, but not both.^[1]
• For continent stomas, only one of a stoma cap (A5055), plug (A5081), absorptive cover (A5083) or gauze pads (A6216) is used on a given day.^[1]

Refills and how much can ship at once

• The supplier must contact you and get your OK before each refill. It must not ship automatically on a set schedule, even if you agreed to that.^[1]
• The supplier can contact you no sooner than 30 calendar days before your current supply is expected to run out, and deliver no sooner than 10 calendar days before.^[1]
• A supplier must not ship more than a 1-month supply at a time to someone in a nursing facility, or more than a 3-month supply to someone at home.^[1]
• A Standard Written Order from your treating practitioner is required before the supplier bills.^[1][3]

Other rules worth knowing

• Pouch covers are coded A9270 and denied as noncovered.^[2]
• Ostomy supplies are not separately payable during a covered home health episode; the home health agency provides them.^[2]
• Ostomy clamps are payable only when ordered as a replacement; clamps billed with pouches are denied as not separately payable.^[2]
• Irrigation sleeves (A4436, A4437) are a monthly allowance: no more than 1 unit per 30 days.^[2]
• A “high output” pouch has a capacity of 0.75 liters or more.^[2]
• Barriers have separate codes for extended wear vs standard wear, and for built-in convexity vs flat.^[2]

Usual maximum quantities (LCD L33828)

Quantities are from the LCD table. Descriptors are the HCPCS long descriptors from the CMS HCPCS quarterly file.^[5] The unit is what the descriptor says (usually “each”; some codes are per ounce or per month). “Products” counts items in our database with that code stated by the manufacturer (or, for smaller brands, by the retailer). Codes not in this table have no usual maximum listed in the LCD.

Sources

1. LCD L33828: Ostomy Supplies (CMS Medicare Coverage Database), Revision Effective Date 01/01/2024
2. LCD-related Policy Article A52487: Ostomy Supplies - Policy Article, Revision Effective Date 01/01/2022
3. Article A55426: Standard Documentation Requirements for All Claims Submitted to DME MACs
4. Medicare.gov: Ostomy supplies coverage
5. CMS HCPCS Quarterly Update, October 2026 alpha-numeric HCPCS file (code descriptors)

LCD L33828 (revision effective 01/01/2024), Policy Article A52487 (revision effective 01/01/2022) and Article A55426, as shown on the CMS pages; all sources checked Nov 4, 2026.