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General coding and policy information, not medical or billing advice for any individual.
Short answer
A5120 is the HCPCS code Medicare’s ostomy supplies policy uses for individual skin barrier wipes or swabs. Under Local Coverage Determination L33828, wipes (A5120) or a liquid or spray barrier (A4369) are each appropriate when a liquid barrier is necessary, but using both is not reasonable and necessary. The usual maximum is 150 wipes per six months.
Definition and scope
HCPCS codes beginning with A5 cover ostomy supplies, which Medicare treats as durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). CMS’s provider compliance tips say Medicare covers ostomy supplies for a patient with a surgically created opening (a stoma) to divert urine or fecal contents, including colostomy, ileostomy and urinary ostomy. Use for other purposes is denied as non-covered.
The LCD refers to A5120 as “individual wipes or swabs”. Related pouch codes A5051, A5061 and A5071 appear in the same policy’s quantity table, so this page covers them only for their usual limits. For what an ostomy pouch is, see what an ostomy bag is; for how the wider category works, see the durable medical equipment list and Medicare DME coverage.
How the policy treats A5120 in practice
A5120 versus A4369: wipes or liquid, not both
L33828 states: “When a liquid barrier is necessary, either liquid or spray (A4369) or individual wipes or swabs (A5120) are appropriate.” It continues: “The use of both is not reasonable and necessary.” The two are alternatives in the policy, not a combined set.
AU modifier
Policy Article A52487, which accompanies the LCD, says: “When codes A4450, A4452, and A5120 are used with ostomy supplies, they must be billed with the AU modifier.” It adds that these three are the only codes for which the AU modifier may be used for this policy. Related pages on modifiers, such as the KX modifier, cover different rules.
Usual maximum quantities from L33828
The LCD says its table “lists the maximum number of items/units of service that are usually reasonable and necessary.” The figures below are copied from that table (revision effective for services on or after 1 January 2024).
| Code | Item as the LCD refers to it | Usual maximum |
|---|---|---|
| A5120 | Individual wipes or swabs (skin barrier) | 150 per 6 months |
| A4369 | Liquid or spray barrier | 2 per month |
| A5051 | Pouch code listed in the table | 60 per month |
| A5061 | Pouch code listed in the table | 20 per month |
| A5071 | Pouch code listed in the table | 20 per month |
The LCD also limits how much a supplier dispenses at once: no more than a three-month supply for a beneficiary at home, and a one-month supply for a beneficiary in a nursing facility.
Where it matters for labs, clinics and supply decisions
Checklist drawn from the three CMS documents, for staff who handle ostomy supply records:
- Confirm the record shows a surgically created stoma, since that is the covered condition (CMS compliance tips).
- Do not record both A5120 wipes and an A4369 liquid or spray barrier for the same need (L33828).
- Bill A5120 with the AU modifier (A52487).
- If quantity exceeds the LCD table, the patient’s medical record must clearly document the explanation for the greater quantity (CMS compliance tips).
- Refills are billed on prospective use, not retrospective, and proof of delivery is required (CMS compliance tips).
Skin barrier products in general are discussed in what Cavilon is; that page is about a product, not the HCPCS code.
Common misunderstandings
- The limits are not absolute. The LCD calls them usual maximums, and quantities above the table need a documented explanation in the medical record.
- A code is not coverage. Having a code does not mean an item is covered for a given patient; the stoma requirement and other policy conditions apply.
- Wipes and spray are not stacked. The policy treats them as alternatives.
FAQ
What is HCPCS A5120?
It is the code the Medicare ostomy supplies LCD (L33828) uses for individual skin barrier wipes or swabs.
How many A5120 wipes does Medicare usually allow?
L33828 lists 150 per six months as the usual maximum. More may be supplied only with documented explanation in the medical record.
Does A5120 need a modifier?
Yes. Policy Article A52487 says A5120, with A4450 and A4452, must be billed with the AU modifier when used with ostomy supplies.
What are A5051, A5061 and A5071?
They are pouch codes that appear in the same quantity table, with usual maximums of 60, 20 and 20 per month respectively.
Can wipes and a liquid barrier be used together?
The LCD says using both is not reasonable and necessary.
Sources
- CMS Medicare Coverage Database, LCD L33828, Ostomy Supplies, checked 30 October 2026.
- CMS Medicare Coverage Database, Policy Article A52487, Ostomy Supplies, checked 30 October 2026.
- CMS Medicare Learning Network, Medicare Provider Compliance Tips: Ostomy Supplies, checked 30 October 2026.
