CORRECT CODING – TRACHEOSTOMY TUBES
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 length, diameter, cuff type, material, etc. are included in HCPCS codes A7520 and A7521, including customized tracheostomy tubes.
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: https://www.dmepdac.com/
Published by Noridian as the PDAC, November 2015. Republished by Palmetto GBA as the PDAC, February 2019. Please note that links in this document were accurate at the time of original publication and may change over time and are no longer active.