Medicare Part B Tracheostomy Supply Billing in a SNF: What Pays and What Doesn't

Medicare Part B pays a skilled nursing facility for tracheostomy supplies once a resident is off Part A. That covers tubes, inner cannulas, a daily care kit, and tube holders. Medicare files them under the prosthetic device benefit. The claim goes to your A/B MAC under the facility's NPI, and Medicare pays the facility. Suction catheters and shower protectors don't pay.

Your nurses chart trach care every shift. The order names the tube. The supply room logs every kit that leaves the shelf.

Now pull your last Part B remittance and look for a trach code.

If there isn't one, your building is the family that keeps every receipt in a shoebox and never files the return. The paperwork is perfect. The refund stays with the government. (The IRS doesn't call to remind you. Medicare doesn't either.)

How a trach claim goes missing

The trach goes in at the hospital. The resident comes to you on a Part A stay, and for those weeks there is no Part B claim to file. The per diem already paid for the supplies. Skipping the claim is the right call.

Then Part A ends. The tube is still in. The kits still come off the shelf every day. The billing routine from admission week stays exactly where it was.

From there it goes 1 of 2 ways.

An outside supplier ships the trach supplies and bills Medicare under its own number. Medicare pays the supplier.

Or your building buys the supplies itself and sends no claim at all. Medicare keeps the money.

Either way, your nurses did the work and your building got $0 from Part B.

What Part B pays for

CMS covers trach supplies under the prosthetic device benefit, Social Security Act §1861(s)(8). The published coverage rules live in LCD L33832, Tracheostomy Care Supplies. It lists what pays and a usual maximum for each code:

• Tubes. A7520 is a non-cuffed tube. A7521 is a cuffed tube. Either one pays 1 every 3 months. A7522 is a stainless steel reusable tube, 1 every 12 months.
• Inner cannula. A4623, 62 a month.
• Care kit, established trach. A4629, 31 a month. That's 1 a day.
• Care kit, new trach. A4625, only for the first 2 weeks after an open surgical tracheostomy.
• Tube holder or collar. A7526, 31 a month.
• Plug or stop. A7527, 2 every 3 months.
• Stoma stent, stud, or button. A7524, 1 every 3 months.
• Filter. A4481, 62 a month.
• Cleaning brush. A4626, 2 a month.

"Usual maximum" means what it says. A resident who needs more can get more, and the chart has to say why.

4 traps sit inside that list.

Fenestration doesn't change the code. The tube codes split on cuffed, non-cuffed, and stainless steel. A fenestrated cuffed tube is still A7521.

Count from the surgery date. A4625 stops paying 2 weeks after the operation. Past day 14, the kit code is A4629.

A plug cancels a tube. The LCD treats A7527 as an alternative to a tube. Bill a plug, and the tube codes deny for that resident.

The brush rides in the kit. A4626 doesn't pay separately when you bill it with a care kit.

Heat and moisture exchangers sit in their own code range, A7503 through A7509, written for tracheostoma systems. Look the exact product up on the PDAC product classification list before you pick a code.

What Part B won't pay for

• Suction catheters. Medicare treats tracheal suction catheters (A4624) and oropharyngeal ones (A4628) as supplies for a suction pump. The pump is durable medical equipment. Medicare doesn't pay for DME used inside a SNF, so the pump and its catheters stay on your supply budget.
• Shower protectors. A7523. The LCD calls it a convenience item and doesn't cover it.
• Anything during a covered Part A stay. The per diem already paid for it.

The billable list is shorter than the supply closet. I'd rather you hear that from me than from an auditor.

Trach is also a small category. A building has far fewer trach residents than wound or catheter residents. Each one uses these supplies every single day.

What goes in the file

Start with the order. The treating practitioner (a physician, NP, PA, or clinical nurse specialist) writes it. It names the item and the quantity.

Then line up the tube in the order, the tube on the supply record, and the code on the claim. If the order says cuffed and the claim says A7520, the claim is wrong before it leaves the building.

Then the chart. It has to show the trach, the ongoing need, and the reason for any quantity over the usual maximum.

The prosthetic device benefit also carries a permanence test. CMS reads "permanent" as long and indefinite duration, in the treating practitioner's judgment (Medicare Benefit Policy Manual, Chapter 15, §120).

CMS audits this category. In its 2024 review of trach supply claims, 25.6% of the dollars were paid improperly, about $6.5 million. 55.9% of that traced to insufficient documentation.

Those were supplier claims. A supplier has to ask your building for the chart. Your building already has it.

That shoebox is the strongest thing you own. File the return.

A caution: the DME MACs wrote that LCD, and your claim goes to an A/B MAC. Confirm with your MAC that it applies the same limits before you bill to them.

Whose number is on the claim

In February 2026, CMS opened CRUSH, a request for public comment on fraud and waste in Medicare. The same week, it froze new Medicare enrollment for DMEPOS medical supply companies for 6 months.

CMS's own count: $1.9 billion in improper DMEPOS payments in fiscal 2024, a 21.4% improper payment rate. That number covers every DMEPOS supplier in every setting. "Improper" covers any claim that missed a rule, from a missing signature on up.

Medicare is looking hard at who bills for supplies. When the claim carries your NPI, every answer an auditor wants is already in your building.

Your NPI, your order, your chart, your claim.

Who does the work

Burst does the billing. We read the trach documentation your clinical team already writes in PointClickCare (read-only), match each tube and supply to LCD L33832, check quantities against the usual maximums, and prepare claims under your facility's NPI. This is one of five categories in Burst's Medicare Part B supply billing service. See the full Part B supply list.