In a recent MLN Connects Newsletter, CMS reports continued improper payments for tracheostomy supplies, with insufficient documentation remaining the leading cause of errors. Recent DME MAC analysis identified more than 13,000 denied claims for tracheostomy-related supplies during the second quarter of 2026, including tracheostomy tubes, care kits, cleaning supplies, dressings, and accessories.

Common reasons for denial include insufficient documentation of:

• Supply quantities billed
• Medical necessity for quantities above policy limits
• Refill requirements for recurring supplies
• Continued need for supplies
• Coverage criteria for tracheostomy care and starter kits

To help prevent denials:

• Ensure medical records support the quantity of supplies billed and clearly document any clinical need for amounts that exceed Medicare's usual allowances.
  • When excess quantities are provided, the medical record should include detailed justification for additional utilization.
• Refill documentation is critical.
  • For recurring supplies, records must show that the beneficiary requested or confirmed the refill before additional supplies were dispensed.
  • Missing refill documentation can result in claim denial, even when the order, proof of delivery, and practitioner records are available.
• Medicare generally considers HCPCS code A4625 (tracheostomy care or cleaning starter kit) medically necessary only during the immediate post-surgical period.
  • Claims submitted beyond that timeframe may be denied as not reasonable and necessary.

For additional guidance, review the Tracheostomy Care Supplies Local Coverage Determination (LCD) L33832, associated Policy Article A52492, and Standard Documentation Requirements for All Claims Submitted to the DME MACs Article A55426 before submitting claims.