Suction Pumps

Suction pumps and related supplies are covered only when they meet Medicare benefit eligibility and are reasonable and necessary per statutory/regulatory requirements. Gastric pumps (E2000) are covered for inability to empty gastric secretions; respiratory pumps (E0600) are covered only for specific causes of impaired secretion clearance (cancer/surgery of throat or mouth, dysphagia, unconsciousness, or tracheostomy) with specified HCPCS-based supply limitations (A4605, A4624, A4628, A4216/A4217). Coverage requires proper documentation (SWO/WOPD, proof of delivery, documented refill requests), adherence to coding rules and PDAC designations for wound pumps, and specific frequency limits (e.g., ≤3 A4624/day, ≤3 A4628/week, maximum 3-month supply).

"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 appli..."