FAQ 6: Are Tracheostoma Valves and HME's covered under Medicare?
YES! Several new HCPCS (HCFA Common Procedure Coding System) codes have been established to bill for tracheostoma valves and for tracheostoma heat and moisture exchangers. These HCPCS codes are effective for dates of service on or after January 1, 2001.
A tracheostoma valve (HCPCS code A7501) is a device that is used by some laryngectomy patients who have had a tracheoesophageal puncture procedure and have a "voice prosthesis" in their tracheoesophageal puncture site. It consists of a plastic body which contains a thin silicone diaphragm. The valve body fits into a plastic housing which is held in place over the tracheostoma by an adhesive disc made of tape or foam. The diaphragm of the tracheostoma valve closes during speaking to allow air to flow from the trachea through the voice prosthesis and into the esophagus to produce speech. Without a tracheostoma valve, the patient with a tracheoesophageal voice prosthesis would have to occlude the opening of the tracheostoma with their finger in order to be able to speak.
A tracheostoma valve (HCPCS code A7501) is to be distinguished from a tracheostomy speaking valve (HCPCS code L8501). A tracheostomy speaking valve (HCPCS code L8501) is a device which is attached to a tracheostomy tube. During speaking, the diaphragm in this device closes to keep air from flowing out through the tracheostomy tube, and instead directs air to flow normally through the larynx. In contrast, the tracheostoma valve described by HCPCS code A7501 is used over a tracheostomy stoma in a patient who has had their larynx removed and has a tracheoesophageal voice prosthesis, but who does not have a tracheostomy tube.
A tracheostoma HME (Heat and Moisture Exchanger) system (HCPCS codes A7503-A7509) is used by some patients with a tracheostoma to add warmth and water vapor to the air when they take in a breath. It consists of a plastic cassette/ holder which contains a filter made of foam, paper, or other material. The holder fits into a plastic housing which is held in place over the tracheostoma by an adhesive disc. A heat and moisture exchanger may be used by itself or in addition to a tracheostoma valve (HCPCS code A7501).
Below is a list of the new HCPCS codes and the brand names and manufacturers of some of the products that would be billed using each HCPCS code. Questions concerning the coding of other products should be directed to the SADMERC.