Medicare Part B Tracheostomy Supply Billing for Skilled Nursing Facilities

Tracheostomy residents are a small share of most skilled nursing populations, but their supply use is steady and predictable: care kits, inner cannulas, ties or holders, and a replacement tube on a regular schedule. For residents who are not in a covered Part A stay, those supplies are a Medicare Part B benefit.

Who Qualifies

Policy Article A52492 covers supplies for care of a tracheostomy site for a beneficiary following an open surgical tracheostomy that has been open, or is expected to remain open, for at least three months. The resident's record should show the tracheostomy, when it was performed, and that it is expected to stay open.

For a resident in a covered Part A stay, these supplies are part of the SNF PPS payment under consolidated billing and cannot be billed separately. Part B billing applies once the resident is not in a covered Part A stay. See the consolidated billing rules.

What LCD L33832 Covers, and How Much

The LCD lists the maximum quantity of each item that is usually reasonable and necessary. A resident may need more or less; anything above the listed amount needs a clear explanation in the medical record, or the excess is denied.

Coding Rules That Cause Denials

• Starter kit vs established kit. A4625 is for the first two weeks after an open surgical tracheostomy. From week three on, kits are coded A4629; A4625 billed after that point is denied.
• Kits are complete. A care kit is meant to supply everything needed for care of the tracheostomy site, so extra quantities of the same items are not billed for site care. Cleaning brushes (A4626) are not billed separately with A4625 or A4629.
• Tubes are all-inclusive. A7520, A7521 and A7522 cover every variation of tube construction, including tubes labeled "customized." Miscellaneous codes such as A9999 or E1399 must not be used for a tracheostomy tube.
• Plugs replace tubes. When a resident receives a tube plug/stop (A7527), claims for tubes A7520, A7521 and A7522 are denied.
• Convenience items. A7523 (tracheostomy shower protector) is a convenience item and is not covered.
• AU modifier. Tape (A4450, A4452) and wipes or swabs (A5120) billed for tracheostomy care without the AU modifier are rejected.

What Every Claim Needs

The LCD requires a Standard Written Order before the claim is submitted, a medical record that supports the items and quantities, and proof that the items reached the resident. Recurring supplies are billed on prospective, not retrospective, use, with continued need confirmed before each new supply. These are the same four elements that apply across the other supply categories; the step-by-step billing guide walks through them.

Why Facilities Miss This Category

Tracheostomy supplies usually arrive through a supplier who bills Medicare under its own NPI, the same pattern as ostomy and urological supplies. The facility's nurses and respiratory staff do the care and the charting, but the reimbursement goes to the supplier. The comparison is laid out in supplier-billed vs facility-NPI billing.

What Burst Does

Burst reads the tracheostomy care documentation already in PointClickCare (read-only), matches supply use to LCD L33832 and its policy article, checks quantities against the usual maximums, and prepares claims under your facility's NPI. Human QA runs on every claim. This is one of five categories in Burst's Medicare Part B supply billing service, alongside surgical dressings and splints and orthotics.

Compliance Note

This article is general information, not legal or billing advice. LCD L33832 and Policy Article A52492 are written for DMEPOS suppliers billing DME MACs; how their criteria apply to a facility's institutional Part B claim should be confirmed with your A/B MAC. Codes, quantities and descriptors change, so verify them against the current documents.

References

• LCD L33832, Tracheostomy Care Supplies (CMS Medicare Coverage Database)
• Policy Article A52492, Tracheostomy Care Supplies (CMS Medicare Coverage Database)
• 42 U.S.C. § 1395x
• Medicare Claims Processing Manual, Chapter 7 (SNF Part B Billing)