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 who 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 providing a very specific 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 payment 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 furnishing oxygen to a patient since the monthly durable medical equipment benefit already includes an allowance for such devices. 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 in the physician. After 36 months home care suppliers may bill Medicare for transtracheal catheters and related supplies using HCPCS codes listed in the SCOOP Rx Template (link above). The current HCPCS code for "transtracheal oxygen catheter, each" is A4608.

Patients are advised to confer with their home oxygen supplier when considering changing from nasal prongs to transtracheal oxygen. To avoid problems with payment and delivery of transtracheal supplies, the patient should know whether or not the supplier participates in Medicare and accepts assignment. If they do not, the supplier needs an ABN (Advance Beneficiary Notice) or waiver signed by the patient acknowledging that transtracheal oxgyen supplies will be initially charged to the patient. Option 1 of the ABN requires that the supplier bill Medicare and refund any amounts charged for supplies, less deductibles and co-payments, if the claim is paid.

 

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