Long-standing questions regarding Medicare's reimbursement policy for transtracheal oxygen products have recently been clarified.  Reimbursement for transtracheal catheters and associated supplies has varied tremendously from region to region, and state to state over the past 10 years.  In its latest ruling, Medicare has determined that the use of home oxygen equipment (including transtracheal catheters) is covered under the durable medical equipment benefit of the Medicare program.   Catheters used in the administration of transtracheal oxygen are also covered as DME supplies in those cases in which they are medically necessary for the patient to receive home oxygen treatment.

Medicare's payment rules for home use of oxygen are governed by section 1834 of the Social Security Act which requires that Medicare pay for home use of stationary oxygen with a single monthly payment amount that includes the oxygen equipment and all necessary supplies. The law does not permit separate payment for any additional items, such as nasal prongs, masks, tubing, humidifiers, or transtracheal catheters used in furnishing oxygen to a patient.  The monthly payment already includes an allowance for such devices.

To paraphrase Medicare's position, the established fee schedule for home oxygen includes an allowance for all necessary supplies.   Therefore, all participating vendors (i.e. home oxygen companies) are obligated without additional reimbursement to provide two transtracheal catheters and a SCOOP hose every 90 days as prescribed.  When the attending physician specifies oxygen delivery through a transtracheal catheter in item 5 of the HCFA 484 form, the oxygen equipment and supplies provided by the home oxygen company must conform fully to what has been prescribed by the physician.

HCFA has approved a staged procedure code for insertion of transtracheal catheters for both the Modified Seldinger and FastTract procedures which allows physicians to bill Medicare for reimbursement of both the initial insertion of the stent and for the introduction of the SCOOP catheter over a wire guide.  The AMA has defined the physicians transtracheal procedure code for the Modified Seldinger procedure as 31730 for the initial insertion and 31730-58 (modifier) for the SCOOP insertion.   McGraw-Hill covers the procedure the following way; use the code 31730 for the stent insertion and 31731 for the placement for the SCOOP catheter.  The AMA has defined the physicians transtracheal procedure code for the FastTract procedure as follows:  Code 31610* for the Tracheostomy fenestration with skin flaps, code 15838* for the Excision of excessive skin and subcutaneous tissue, code 31730 for the Transtracheal (percutaneous) introduction of needle wire dilator/stent or indwelling tube for oxygen therapy.  For Trachea scar revision when using FastTract to redo a "lost tract" from a Modified Seldinger, use code 31830.

*Billing codes 31610 and 15838 are not bundled codes.  Make sure your post surgical dictation clearly reflects that you performed both procedures, and make sure you bill for both procedures.

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