| Qty Allowed / Duration | |
| Pouches (Closed) | 60 per month |
| Pouches (Drainable) | 20 per month |
| Pouches (Urinary) | 20 per month |
| Wafers (4 x 4) | 20 per month |
| Wafers (6 x 6) | 20 per month |
| Wafers (8 x 8) | 20 per month |
| Stoma Cap | 31 per month |
| Lubricant | 4 oz. per month |
| Irrigation cone/bag | 1 every 3 months |
| Irrigation Sleeve | 4 per month |
| Stomahesive Paste | 4 oz. per month |
| Adhesive | 4 oz. per month |
| Adhesive Remover (liquid) | 8 oz. every 3 months |
| Adhesive Discs | 10 per month |
| Convex Inserts | 10 per month |
| Ostomy Belt | 1 per month |
| Appliance Cleaner | 16 oz per month |
| Tape (depending on tape width) | 1-2 rolls per month |
| Skin Barrier Wipes | 3 Boxes/50 every 6 months |
| Ostomy Deodorant, liquid or tablet | no set allowable amount |
| Drainage Bottle | 1 every 3 months |
| Drainage bag | 1 per month |
| Ostomy absorbent packets | 90 per month |
Medicare covers ostomy supplies for use on patients with a surgically
created opening (stoma) which diverts urine, or fecal contents outside the body.