Having trouble finding the Tracheostomy Supplies you need or finding a supplier that will accept Medicare Assignment?
Better Living Now is here to help you. We carry all your supplies and we work with you towards providing your supplies under Medicare assignment through our Preferred Program.
If you are covered under Medicare, many of your medically necessary supplies and related products may be covered!
To get started enroll today or print out an Tracheostomy Supplies Order Form, bring it to your doctor and mail your or fax your order to us. It is that easy!
How The Program Works
Tracheostomy Supplies Allowable Amounts
Better Living Now has developed preferred product relationships with industry leading manufacturers in an effort to bring you the highest quality products available that will be 100% covered by your insurance/Medicare plan with no additional out-of-pocket expense to you. Tracheostomy Supplies Allowable Amounts - Effective 02/04/2011
Product Description
Allowable Amount
A4450 TAPE, NON-WATERPROOF, PER 18 SQUARE INCHES
A4452 TAPE, WATERPROOF, PER 18 SQUARE INCHES
A4625 TRACHEOSTOMY CARE KIT FOR NEW TRACHEOSTOMY
A4626 TRACHEOSTOMY CLEANING BRUSH, EACH
A4629 TRACHEOSTOMY CARE KIT FOR ESTABLISHED TRACHEOSTOMY
Notes - none
Tracheostomy Supplies Guidelines
General InformationFor more information on local coverage determination Local Coverage Determination (LCD) for Tracheostomy SuppliesIndications and Limitations of Coverage and/or Medical Necessity
For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable
and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body
member, and 3) meet all other applicable Medicare statutory and regulatory requirements. For the items addressed in
this local coverage determination, the criteria for "reasonable and necessary", based on Social Security Act §
1862(a)(1)(A) provisions, are defined by the following indications and limitations of coverage and/or medical necessity.
For an item to be covered by Medicare, a written signed and dated order must be received by the supplier before a claim
is submitted. If the supplier bills for an item addressed in this policy without first receiving the completed order, the item
will be denied as not reasonable and necessary.
The statutory coverage criteria for tracheostomy supplies are specified in the related Policy Article.
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, will be denied as not
reasonable and necessary.
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 have substantiating documentation available upon request.
Quantities of supplies greater than those described in the policy as the usual maximum amounts, in the absence of
documentation clearly explaining the medical necessity of the excess quantities, will be denied as not reasonable and
necessary.
For information on tracheal suction catheters and related supplies, see the Suction Pump policy.
Documentations Requirements
Section 1833(e) of the Social Security Act precludes payment to any provider of services unless "there
has been furnished such information as may be necessary in order to determine the amounts due such
provider." It is expected that the patient's medical records will reflect the need for the care provided. The
patient's medical records include the physician's office records, hospital records, nursing home records,
home health agency records, records from other healthcare professionals and test reports. This
documentation must be available upon request.
An order for each item billed must be signed and dated by the treating physician, kept on file by the
supplier, and made available upon request. Items billed before a signed and dated order has been
received by the supplier must be submitted with an EY modifier added to each affected HCPCS code.
When billing for quantities of supplies greater than those described in the policy as the usual maximum
amounts, there must be clear documentation in the patient's medical records corroborating the medical
necessity of the amount(s).
The ICD-9 code that justifies the need for these items must be included on the claim.
Refer to the Supplier Manual for more information on documentation requirements.
RefillsFor more information on local coverage determination Local Coverage Determination (LCD) for Tracheostomy Supplies
