A4628, Oral and/or oropharyngeal suction catheter, each
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- A completed Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted; for DMEPOS base items that require WOPD the supplier must have received a signed WOPD before delivery.
- For DMEPOS base items requiring WOPD plus separately billed options/accessories/supplies, the WOPD must list the base item (and may list associated items) prior to delivery; associated items billed without WOPD will be denied.
- Suppliers must maintain proof of delivery (POD) documentation and make POD available to the Medicare contractor upon request.
- For refills, suppliers must contact the beneficiary and document an affirmative response no sooner than 30 calendar days before expected end of current supply and retain that documentation prior to dispensing the refill.
Key Coverage Criteria
- An item is covered only if it meets Medicare benefit category eligibility, is reasonable and necessary for diagnosis/treatment or to improve function of a malformed body member, and meets all applicable Medicare statutory and regulatory requirements.
- Gastric suction pump (E2000) is covered for beneficiaries unable to empty gastric secretions through normal gastrointestinal function.
- Respiratory suction pump (E0600) is covered for beneficiaries who have difficulty raising and clearing secretions secondary to cancer or surgery of the throat/mouth, dysfunction of swallowing muscles, unconsciousness/obtunded state, or tracheostomy.
- Suction catheters (A4605, A4624, A4628) and sterile water/saline (A4216, A4217) are covered when medically necessary and used with a medically necessary E0600 pump.
- Tracheal suction catheters (A4624) are reasonable and necessary only when the beneficiary has a tracheostomy and requires a covered E0600 pump for tracheostomy suctioning.
- Closed system catheters (A4605) are reasonable and necessary only when the beneficiary has a tracheostomy, requires a covered E0600 for tracheostomy suctioning, and requires use of a covered ventilator.
1 Active Policy
L33612, Suction Pumps
Related Codes
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