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November 12, 2015

Tracheostomy Tubes - Correct Coding

Joint DME MAC Publication

Recently the PDAC and DME MACs have received questions about the proper coding of "customized" tracheostomy tubes. Manufacturers often describe customized tracheostomy tubes as those having a non-standard shaft length or diameter. Variations in construction materials, cuff type, etc. are also sometimes used by manufacturers to define a non-standard product.

The HCPCS codes for tracheostomy tubes are:

A7520 - TRACHEOSTOMY/LARYNGECTOMY TUBE NON-CUFFED, POLYVINYLCHLORIDE (PVC), SILICONE OR EQUAL, EACH
A7521 - TRACHEOSTOMY/LARYNGECTOMY TUBE CUFFED, POLYVINYLCHLORIDE (PVC), SILICONE OR EQUAL, EACH

Both codes are all-inclusive. All variations in tracheostomy tube construction such as dimensions, materials, cuffs, connectors etc., including all variation often classified by tube manufacturers as customized tracheostomy tubes are included in HCPCS codes A7520 and A7521.

Miscellaneous or NOC (not otherwise classified) codes such as E1399 (DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS) or A9999 (MISCELLANEOUS DME SUPPLY OR ACCESSORY, NOT OTHERWISE SPECIFIED) must not be used to bill Medicare for any tracheostomy tube. Use of a miscellaneous code to bill Medicare for any tracheostomy tubes is incorrect coding.

For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website: http://www.dmepdac.com/External Website

For additional information on coding and documentation requirements, please review the Tracheostomy Care Supplies LCDExternal Website and Policy ArticleExternal Website

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