Medicare Reimbursement

Medicare’s reimbursement for transtracheal catheters and associated supplies has varied tremendously from region to region, and state to state since its inception in the mid 1980’s. In the past, Medicare has determined that the use of home oxygen equipment (including transtracheal catheters) is covered under the durable medical equipment benefit of the Medicare program. Catheters used in the administration of transtracheal oxygen are also covered as DME supplies in those cases in which they are medically necessary for the patient to receive home oxygen treatment.

Medicare's payment rules for home use of oxygen are governed by section 1834 of the Social Security Act which requires that Medicare pay for home use of stationary oxygen with a single monthly payment amount that includes the oxygen equipment and all necessary supplies. The law does not permit separate payment for any additional items, such as nasal prongs, masks, tubing, humidifiers, or transtracheal catheters used in furnishing oxygen to a patient. The monthly payment already includes an allowance for such devices.

To paraphrase Medicare's position, the established fee schedule for home oxygen includes an allowance for all necessary supplies. Therefore, all participating vendors (i.e. home oxygen companies) are obligated without additional reimbursement to provide two transtracheal catheters and a TTO hose every 90 days as prescribed. Although HCPCS codes have been in existence for many years, there hasn’t always been a dollar figure associated with the code. As all oxygen dependent patients already know, Medicare has instituted substantial reductions in the monthly allowance for oxygen reimbursement. This has had a very significant (adverse) impact on the oxygen supply industry. Patients should confer with their home oxygen company if they are considering getting a transtracheal catheter to insure they will be supplied with replacement catheters on schedule.

A staged procedure code has been approved for insertion of transtracheal catheters for both the Modified Seldinger and Fast Tract procedures which allows physicians to bill Medicare for reimbursement of both the initial insertion of the stent and for the introduction of the transtracheal catheter over a wire guide. The AMA has defined the physicians transtracheal procedure code for the Modified Seldinger procedure as 31730 for the initial insertion and 31730-58 (modifier) for the TTO insertion. The AMA has defined the physicians transtracheal procedure code for the Fast Tract procedure as follows: Code 31610* for the tracheostomy fenestration with skin flaps, code 15838* for the Excision of excessive skin and subcutaneous tissue, code 31730 for the transtracheal (percutaneous) introduction of needle wire dilator/stent or indwelling tube for oxygen therapy. For tracheal scar revision when using Fast Tract to redo a "lost tract" from a Modified Seldinger, use code 31830. Additionally, many TTOT programs that utilize respiratory therapists to do scheduled, routine catheter strippings are using CPT code 31502 for these visits.

 

Procedure CMS Code
T-9 (Modified Seldinger) Initial Insertion Procedure 31730
T-9 (Modified Seldinger) Catheter Placement 31731 (31730-58)
T-10 (FastTract) Tracheostomy Fenestration with Skin Flaps 31610*
T-10 (FastTract) Excision of Excessive Skin and Subcutaneous Tissue 15838*
T-10 (FastTract) Catheter Placement 31730
T-10 (FastTract) Scar Revision from Lost Tract 31830

*Billing codes 31610 and 15838 are not bundled codes. Make sure your post surgical dictation clearly reflects that you performed both procedures, and make sure you bill for both procedures.

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