Medicare Reimbursement

Under the Competitive Bidding Program, a home care supplier (DME) that participates in Medicare must provide transtracheal catheters and related supplies as part of the durable medical equipment allowance as stated in the federal rules for home oxygen therapy (» ICN 908804)Accordingly, the current Medicare Home Oxygen Therapy Order lists "A4608 - transtracheal catheter" under Means of Oxygen Delivery and Accessories (» Template v4.2). Section 5.9 of the Medicare Program Integrity Manual states, "If replacement supplies are needed for the therapeutic use of purchased DMEPOS (durable medical equipment), the treating physician must specify on the order, or on the CMN, the type of supplies needed and the frequency with which they must be replaced, used, or consumed." 

The physician can facilitate the timely replacement of transtracheal catheters and supplies by prescribing home oxygen with a precisely worded Detailed Written Order (» SCOOP Rx Template), or a certificate of medical necessity, customized for transtracheal catheters and related supplies  CMS 484.5 SCOOP Version). The oxygen supplier often completes sections A and C of the CMN, but before signing the document, the physician should confirm that it accurately reflects the equipment and transtracheal supplies being prescribed. The oxygen supplier is required to provide the equipment and supplies specified in the physician's order or CMN and must accommodate the patient's mobility needs both inside and outside the home (» Certain Situations). To avoid problems with reimbursement and delivery of transtracheal supplies, the physician should confirm that the DME participates in Medicare and accepts assignment under the bundled payment system. A DME that participates in Medicare cannot issue an advance written notice of noncoverage (» ABN) to charge a beneficiary for transtracheal supplies since they are included in the Medicare bundled payment for home oxygen equipment and supplies. In spite of Medicare rules that require the DME to provide oxygen equipment and supplies as stated in the detailed written order or CMN, some suppliers delay or refuse to comply with clear orders to replace transtracheal catheters and the security hose every 90 days. Medicare provides a procedure for filing a complaint against a DME (» Complaint).

The Competitive Bidding Program was mandated by Congress through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) which requires a single monthly payment to cover the oxygen equipment and all necessary supplies. Separate payment for any additional items, such as nasal prongs, masks, tubing, humidifiers, or transtracheal catheters used in delivering oxygen is not permitted since the monthly durable medical equipment benefit already covers these items (» CMS 908804 Citations). During the first three years of the five-year global fee cycle, a participating home oxygen supplier is obligated without additional reimbursement to provide two transtracheal catheters and a transtracheal hose every 90 days as prescribed by the physician. Thereafter, the supplier must continue to provide these supplies, but they may bill Medicare for catheters and related items using the HCPCS codes listed with the SCOOP Rx Template (see link above). The current HCPCS code for "transtracheal oxygen catheter, each" is A4608, and the 2019 floor and ceiling amounts are available here (» DME Fee Schedule).

 

The following ICD-10-CM transtracheal procedure codes relate to physician reimbursement:  

31730 - Transtracheal (percutaneous) introduction of needle wire dilator / stent or indewlling tube for oxygen therapy
31610 - FastTract procedure for tracheostomy fenestration with skin flaps 
15838 - Excision of excessive skin and subcutaneous tissue

 

If we can be of additional service, please feel free to contact our Technical Services department at help@tto2.comtelephone 303-790-4766, or 800-527-2667.


Patients                      

Patients

Clinicians                      

Clinicians

Products