Tracheostomy Care Supplies - Policy Article

Tracheostomy care supplies are covered under the prosthetic benefit for beneficiaries with an open surgical tracheostomy expected to remain open at least 3 months; starter kit A4625 is for the first two postoperative weeks and A4629 thereafter. Claims must meet LCD reasonable-and-necessary criteria, include a supporting diagnosis code, and comply with Final Rule 1713 face-to-face and Written Order Prior to Delivery (WOPD) requirements; A4450/A4452/A5120 require AU modifier. Tracheostomy tubes are billed only to A7520–A7522 (misc codes E1399/A9999 prohibited), kit quantities are inclusive, and certain HME and accessory codes have specific billing restrictions.

"Tracheostomy care supplies are covered for beneficiaries following an open surgical tracheostomy that has been open or is expected to remain open for at least 3 months."

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