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LCD - Suction Machine and Supplies

Coverage Summary

  1. Written Order Prior to Delivery
  2. A respiratory suction pump is only covered for patients who have difficulty raising and clearing secretions secondary to:

  • Cancer or surgery of the throat or mouth
  • Dysfunction of the swallowing muscles
  • Unconsciousness or obtunded state
  • Tracheostomy

Order Requirements

  1. Patient's Name
  2. Specific description of ordered items to be delivered
  3. Prescribed settings
  4. Prescribed frequency of use
  5. Length of Medical Need
  6. Treating Physician’s NPI
  7. Treating physician’s legible signature (personally written or electronically signed by the physician, stamps are not accepted by insurance)
  8. Treating physician’s legible signature date (personally written or electronically signed by the physician, stamps are not accepted by insurance)
  9. Start date of the order – if different than physician signature date.

Coverage Detail

A respiratory suction pump (E0600) is only covered for patients who have difficulty raising and clearing secretions secondary to:

  1. Cancer or surgery of the throat or mouth
  2. Dysfunction of the swallowing muscles
  3. Unconsciousness or obtunded state
  4. Tracheostomy

Suction catheters and sterile water/saline are covered and are separately payable when they are medically necessary and used with a medically necessary respiratory suction pump. Supplies used with DME that is denied as not reasonable and necessary will also be denied as not reasonable and necessary.

Closed system catheters and tracheal suction catheters are only covered for patients with a tracheostomy (ICD-9 codes 519.00, 519.01, 519.02, 519.09, V44.0 or V55.0) as described below:

A.       Tracheal suction catheters are reasonable and necessary only when all of the following are met:

  1. The patient has a tracheostomy described by the listed diagnosis codes
  2. The patient requires the use of a covered respiratory suction pump as described above, for tracheostomy suctioning.

B.       Closed system catheters are reasonable and necessary only when all of the following are met:

  1. The patient has a tracheostomy described by the listed diagnosis codes and;
  2. The patient requires the use of a covered respiratory suction pump as described above, for tracheostomy suctioning and;
  3. The patient requires the use of a covered ventilator

More than three tracheal suction catheters per day will be denied as not reasonable and necessary for tracheostomy suctioning.

Oropharyngeal suction catheters (non-tracheal suction catheters) are reasonable and necessary for suctioning in the oropharynx. The oropharynx is not sterile, therefore the catheter can be reused if properly cleansed and/or disinfected. More than three catheters oropharyngeal suction catheters per week will be denied as not reasonable and necessary for oropharyngeal suctioning.

Oral interface for use with a respiratory suction pump to remove secretions for the covered indications described above is non-covered and will be denied as not reasonable and necessary.

Sterile water/saline solution is covered when used to clear a suction catheter after tracheostomy suctioning. Sterile water/saline will be denied as not reasonable and necessary when used for oropharyngeal suctioning.