(1)Indications and Limitations of Coverage:
(a)Use of a home model respiratory suction pump may be covered for a client who has difficulty raising and clearing secretions secondary to:
(A)Cancer or surgery of the throat or mouth; or
(B)Dysfunction of the swallowing muscles; or
(C)Unconsciousness or obtunded state; or
(b)When a respiratory suction pump (E0600) is covered, tracheal suction catheters are separately payable supplies. In most cases, in the home setting, sterile catheters are medically appropriate only for tracheostomy suctioning. Three suction catheters per day are covered for medically appropriate tracheostomy suctioning, unless additional documentation is provided. When a tracheal suction catheter is used in the oropharynx, which is not sterile, the catheter can be reused if properly cleansed and/or disinfected. In this situation, the medical appropriateness for more than three catheters per week requires additional documentation;
(c)Sterile saline solution (A4216, A4217) may be covered and separately payable when used to clear a suction catheter after tracheostomy suctioning. It is not usually medically appropriate for oropharyngeal suctioning. Saline used for tracheal lavage is not covered;
(d)Supplies (A4628) are covered and are separately payable when they are medically appropriate and used with a medically appropriate suction pump (E0600) in a covered setting;
(e)When a suction pump (E0600) is used for tracheal suctioning, other supplies (e.g., cups, basins, gloves, solutions, etc.) are included in the tracheal care kit code, A4625–(see OAR 410-122-0209 (Tracheostomy Care Supplies) for details). When a suction pump is used for oropharyngeal suctioning, these other supplies are not medically appropriate;
(f)The suction device must be appropriate for home use without technical or professional supervision. Those using the suction apparatus must be sufficiently trained to adequately, appropriately and safely use the device.
(2)A client’s medical record must reflect the need for the supplies dispensed and billed. The medical record must be kept on file by the durable medical equipment (DME) provider and made available to the Division of Medical Assistance Programs (Division) upon request.
(3)A portable or stationary home model respiratory suction pump (E0600) is an electric aspirator designed for oropharyngeal and tracheal suction.
(4)A portable or stationary home model gastric suction pump (E2000) is an electric aspirator designed to remove gastrointestinal secretions.
(5)A tracheal suction catheter is a long, flexible catheter.
(6)An oropharyngeal catheter is a short, rigid (usually) plastic catheter of durable construction.
(7)Code E0600 must not be used for a suction pump used with gastrointestinal tubes.
(8)Code E2000 must be used for a suction pump used with gastrointestinal tubes.
(9)Providers should contact the Medicare Pricing, Data Analysis and Coding (PDAC) contractor for guidance on the correct coding of these items.
(10)When billing for quantities of supplies greater than those described in the policy as the usual maximum amounts, there must be clear documentation in the client’s medical records corroborating the medical appropriateness for the higher utilization. The Division may request copies of the client’s medical records that corroborate the order and any additional documentation that pertains to the medical appropriateness of items and quantities billed.
(11)Table 122-0208, Suction Pumps.
Rule 410-122-0208 — Suction Pumps,