Does A4481 require prior authorization?

No, A4481 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for A4481?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`A4481`, Tracheostoma filter, any type, any size, each

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

A Standard Written Order (SWO) must be received by the supplier before a claim is submitted for items addressed in this policy.
For DMEPOS items requiring WOPD, the supplier must have a signed SWO/WOPD before delivery; WOPD may list the base item and associated separately billed options/supplies.

For refills, suppliers must contact the beneficiary (no sooner than 30 days before expected end) and document an affirmative response prior to dispensing; delivery may occur no sooner than 10 days before expected end.

If a beneficiary requires quantities greater than the usual maximum, the clinical justification and explanation for the greater quantity must be clearly documented in the beneficiary's medical record.

Key Coverage Criteria

Tracheostomy care/cleaning starter kit (HCPCS A4625) is covered following an open surgical tracheostomy for the immediate post-operative period.
Tracheostomy supplies are covered when they meet Medicare criteria of being in a defined Medicare benefit category and are reasonable and necessary for diagnosis, treatment, or to improve functioning per SSA §1862(a)(1)(A) and other applicable Medicare rules.

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`A4481`, Tracheostoma filter, any type, any size, each

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

A4481, Tracheostoma filter, any type, any size, each

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

`A4481`, Tracheostoma filter, any type, any size, each