Medicare Reimbursement

Reimbursement for transtracheal catheters and associated supplies has varied tremendously from region to region, and state to state. Under the competitive bidding program, a home care supplier (DME) that participates in Medicare and accepts assignment would provide transtracheal supplies including catheters under the durable medical equipment benefit as stated in federal home oxygen therapy guidelines (ICN 908804). It is crucial that the physician lay a foundation for timely delivery of transtracheal catheters and supplies by prescribing with a precisely worded Detailed Written Order or "DWO" (SCOOP Rx Template).

The Competitive Bidding Program was mandated by Congress through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and requires that the program pay for home oxygen therapy 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 delivering oxygen to a patient since the monthly durable medical equipment benefit already includes an allowance for these items. During the first three years of the five-year global fee cycle, all participating suppliers (i.e., home oxygen companies) are obligated without additional reimbursement to provide two transtracheal catheters and a TTO hose every 90 days as prescribed by the physician. Thereafter, home care suppliers may bill Medicare for catheters and related supplies using the HCPCS codes listed with the SCOOP Rx Template (see link above). The current HCPCS code for "transtracheal oxygen catheter, each" is A4608.

Physicians are advised to inform the DME about plans to change the mode of oxygen delivery from nasal prongs to transtracheal oxygen. To avoid problems with reimbursement and delivery of transtracheal supplies, the physician should determine whether or not the DME participates in Medicare and accepts assignment under the bundled payment system. If it does not participate, the DME would need an ABN (Advance Beneficiary Notice) or waiver signed by the patient indicating that they plan to charge the patient for transtracheal oxgyen supplies in anticipation of possible Medicare denial of coverage. Under Option 1 of the ABN, the DME must bill Medicare then refund any amounts paid by the patient less deductibles and co-pays if the claim is allowed. A DME that participates in Medicare and accepts assignment cannot issue an advance written notice of noncoverage to charge a beneficiary for transtracheal supplies since they are included in the Medicare bundled payment for home oxygen equipment and supplies.

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

 

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