A plain-English breakdown of every Medicare Part B supply category a skilled nursing facility can bill under its own institutional NPI — with the governing LCD, the revenue code, the documentation that has to be on file, and representative HCPCS codes with current 2026 national rates.
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Who this applies to. These categories are billable to traditional Medicare Part B under a facility's institutional NPI only for residents who are not in a covered Part A stay. During a covered Part A stay, the same supplies are bundled into consolidated billing. Durable Medical Equipment (DME) is excluded throughout — it cannot be billed under the institutional NPI.
1
Surgical Dressings
Primary and secondary dressings for a wound caused or treated by a surgical procedure, or following debridement.
LCD L33831Policy Article A54563Revenue Code 623
Documentation that must be on file
Qualifying wound documented by the treating practitioner — type, location, number, and size of each wound; whether the dressing is primary or secondary; amount of drainage.
Wound evaluation updated at least monthly — weekly for residents in a nursing facility or with heavily draining or infected wounds.
Change frequency is clinically consistent — a secondary dressing changed weekly over a primary dressing changed daily will be denied.
Representative codes & 2026 national rates
HCPCS
Description
Ceiling
Floor
A6196
Alginate dressing, ≤ 16 sq in
$10.49
$8.92
A6209
Foam dressing, ≤ 16 sq in, without border
$10.65
$9.05
A6234
Hydrocolloid dressing, ≤ 16 sq in, without border
$9.33
$7.93
A6021
Collagen dressing, ≤ 16 sq in
$29.97
$25.47
A6402
Sterile gauze, ≤ 16 sq in
$0.15
$0.13
A6457
Tubular dressing
$1.62
$1.38
2
Ostomy Supplies
Covered as prosthetic devices — pouches, barriers, and supplies directly related to ostomy care.
LCD L33828Revenue Code 274
Documentation that must be on file
Quantities within the LCD maximum for the ostomy type, location, and skin condition — excess quantities require documented clinical justification.
One barrier form, not both — a liquid/spray barrier (A4369) or wipes/swabs (A5120), but not concurrent use of both.
One-month dispensing limit at a time for residents in a nursing facility.
Representative codes & 2026 national rates
HCPCS
Description
Ceiling
Floor
A4416
Closed ostomy pouch, with barrier & filter
$3.93
$3.34
A5051
Closed pouch, with barrier attached
$2.94
$2.50
A4362
Solid skin barrier
$4.95
$4.21
A4369
Skin barrier, liquid, per oz
$3.46
$2.94
A4367
Ostomy belt
$10.49
$8.92
3
Urological Supplies
A urinary collection and retention system, covered as a prosthetic device for permanent urinary incontinence.
LCD L33803Policy Article A52521Revenue Code 274
Documentation that must be on file
Permanent urinary incontinence documented — temporary incontinence is not covered under this benefit.
One indwelling catheter per month for routine maintenance; more frequent changes require a documented clinical indication.
Intermittent catheter kits capped at 200 units/month combined (A4297 + A4353). Three-month dispensing limit at a time.
Representative codes & 2026 national rates
HCPCS
Description
Ceiling
Floor
A4349
Disposable male external catheter
$2.87
$2.44
A4351
Straight-tip intermittent catheter
$2.58
$2.19
A4353
Intermittent catheter, with insertion kit
$9.99
$8.49
A4338
Indwelling Foley catheter, two-way latex
$17.48
$14.86
A4357
Bedside drainage bag
$13.84
$11.76
A4358
Urinary leg or abdomen bag
$9.46
$8.04
4
Tracheostomy Supplies
Covered under the prosthetic device benefit following an open surgical tracheostomy.
LCD L33832Policy Article A52492Revenue Code 274
Documentation that must be on file
Open surgical tracheostomy that has been, or is expected to remain, open for at least three months.
Care kit A4625 ends at two weeks post-op — claims for A4625 after that point are denied as not reasonable and necessary.
One-month dispensing limit at a time for residents in a nursing facility.
Representative codes & 2026 national rates
HCPCS
Description
Ceiling
Floor
A4623
Tracheostomy inner cannula
$9.34
$7.94
A4625
Tracheostomy care kit, for new tracheostomy
$9.87
$8.39
A4629
Tracheostomy care kit
$6.63
$5.64
A7525
Tracheostomy mask
$2.94
$2.50
5
Enteral Nutrition
Formula, tubing, and supplies for residents who require tube feeding.
LCD L38955Medicare Advantage only
A deliberate scope distinction. Under traditional Medicare, enteral nutrition must be billed to the DME MAC on the professional claim format and requires a National Supplier Clearinghouse supplier number — it is not billed to the A/B MAC on the UB-04 like the categories above. Burst does not maintain that enrollment and does not bill enteral nutrition to traditional Medicare. Where residents carry Medicare Advantage coverage, Burst bills enteral nutrition under the applicable plan's contracted arrangements, which are governed by the plan contract rather than the traditional Medicare fee schedule. Rates are therefore plan-specific and not listed here.
What Burst confirms before submitting
Formula type, tube access route, and caloric requirements documented in the medical record.
Supporting medical necessity consistent with the applicable MA plan's coverage requirements — if documentation is insufficient, the claim is not submitted until it can be obtained.
Not billable under the institutional NPI
Durable Medical Equipment — wound VACs, enteral pumps, wheelchairs, hospital beds, IV poles, and similar equipment — may not be billed to Medicare Part B under a facility's institutional NPI, regardless of Part A status. DME must be billed to the DME MAC by a separately enrolled supplier. Burst identifies and excludes DME at intake.
About these rates. Figures shown are the national ceiling and floor allowable amounts from the CMS DMEPOS fee schedule, April 2026 (Q2). Actual payment is set by CMS, varies by state and jurisdiction, and is updated quarterly — these figures are for planning reference, not a payment quote. Codes shown are representative of each category, not a complete list. Verify the current LCD and fee schedule for your jurisdiction before billing.
This guide is provided by Burst Medical Billing for general educational purposes for skilled nursing facility billing teams. It summarizes federal statute, CMS manual guidance, and Local Coverage Determinations, with rates drawn from the CMS DMEPOS fee schedule for April 2026, and is not legal advice or a guarantee of payment. Coverage rules and rates change; verify current CMS guidance for your jurisdiction before submitting claims. LCD references verified against the CMS Medicare Coverage Database; rates and descriptions sourced directly from the CMS DMEPOS fee schedule.