1. Medicare Guidelines for Suction Pump Supplies and Tracheostomy Supplies
1. Tracheostomy Guidelines
1. A tracheostomy care kit is covered for a patient following an open surgical tracheostomy which has been open or is expected to remain open for at least three months.
2. A tracheostomy care or cleaning starter kit (A4625) is covered following an open surgical tracheostomy. Beginning two weeks post-operatively, code A4625 is no longer medically necessary and, if that code is billed, payment is based on the least costly alternative, code A4629.
3. One tracheostomy care kit (A4625, A4629) per day is considered necessary for routine care of a tracheostomy. Claims for additional kits for non-routine tracheostomy care must be accompanied by substantiating documentation.
2. Suction Pump Guidelines
1. Use of a home model respiratory suction pump (E0600) is covered for patients who have difficulty raising and clearing secretions secondary to:
1. Cancer or surgery of the throat or mouth
2. Dysfunction of the swallowing muscles
3. Unconsciousness or obtunded state
4. Tracheostomy (ICD-9 V44.0 or V55.0)
2. When a respiratory suction pump (E0600) is covered, tracheal suction catheters (A4624) are separately payable supplies. In most cases, in the home setting, sterile catheters are medically necessary only for tracheostomy suctioning. Three suction catheters per day are covered for medically necessary tracheostomy suctioning, unless additional documentation is provided. When a tracheal suction catheter is used in the oropharynx, which is not sterile, the catheter can be reused if properly cleansed and/or disinfected. In this situation, the medical necessity for more than three catheters (A4624) per week would require additional documentation.
3. Sterile saline solution (A4214, A4323) is covered and separately payable when used to clear a suction catheter after tracheostomy suctioning. It is not usually medically necessary for oropharyngeal suctioning. Saline used for tracheal lavage is a non-covered supply.
4. Tracheal suction catheters (A4624) and sterile saline used for suctioning (A4214, A4323) are considered supplies for durable medical equipment. Therefore, when supplied to beneficiaries in nursing facilities, Place of Service Codes 31 and 32, they will be denied as non-covered.
5. Supplies (A4628) are covered and are separately payable when they are medically necessary and used with a medically necessary (E0600) in a covered setting.

When an E0600 is used for tracheal suctioning, other supplies (e.g., cups, basins, gloves, solutions, etc.) are included in the tracheal care kit code, A4625 (refer to the Tracheostomy Care Supplies policy for details). When an E0600 is used for oropharyngeal suctioning, these other supplies are not medically necessary.

Better living Now, Inc. assumes no responsibility in regards to Medicare coverage and has interpreted Medicare Rules for the benefit and understanding of the patient. For detailed information regarding Medicare coverage please visit their web site at: www.cms.gov. For Coverage Information for Tracheostomy Supplies go to: http://www.tricenturion.com/content/dmerc/0602_16_10_Tracheostomy_supplies.cfm