Tracheostomy Supplies
The Standard Written Order (SWO) requirements are in effect for dates of service January 1, 2020 and after.
Refer to the SWO page for the elements needed in this streamlined order.
Coverage
Documentation
- Documentation Checklist – Tracheostomy Care Supplies [PDF] - Checklist to ensure suppliers gather all required documentation
- Clinician's Checklist – Tracheostomy Care Supplies [PDF] – Checklist to assist clinician's in determining what documentation they need to have available for suppliers
Reviews/Audits
- Medical Review – View notifications/findings or pre/post claim reviews completed by Noridian Medical Review
Bundling
Per the bundling table listed in Policy Article A52492
- When the bundled code listed in Column I is billed, the codes in Column II are not separately payable.
- When the codes in Column II are provided at the same time, it must be billed with the bundled code listed in Column I.
| Column I | Column II |
|---|---|
| A4625 | A4626 |
| A4629 | A4626 |
Last Updated Jan 10, 2020