Article Detail - JD DME

Original Effective Date: 12/06/2001           
Revision Effective Date: 11/01/2013

Effective for claims with dates of service on or after January 1, 2002, two new codes have been established for tracheo-esophageal voice prostheses:

• L8507 - Tracheo-esophageal voice prosthesis, patient inserted, any type, each
• L8509 - Tracheo-esophageal voice prosthesis, inserted by licensed health care provider, any type, each

Claims for these items with dates of service prior to January 1, 2002, must continue to be submitted with the miscellaneous code L8499. The new codes are in the prosthetic devices payment category.

These codes describe small tubes that are placed in a surgically created opening between the trachea and esophagus in selected patients who have had a laryngectomy. The tubes have a one-way valve that allows the flow of air from the trachea, through the tube, and into the esophagus, enabling the patient to speak.

Code L8509 describes a device that is designed to be removed and replaced only by a physician or other health care provider. An example (not all-inclusive) of a product described by this code is the Blom-Singer Indwelling Low Pressure Voice Prosthesis (InHealth Technologies).

Code L8507 describes a device that is designed to be removed and replaced by the patient for cleaning. Even if this type of device is inserted by a physician, code L8507 must be used. Examples (not all-inclusive) of products described by this code are: Blom-Singer Duckbill Voice Prosthesis (InHealth Technologies), Blom-Singer Low Pressure Voice Prosthesis (InHealth Technologies), Ultra Low Resistance Voice Prosthesis (Bivona), Duckbill Voice Prosthesis (Bivona).

Suppliers should contact the Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC) for guidance on the correct coding of these devices.