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Tracheostomy Care Supplies - Policy Article

Article A52492 · 7 versions, 2015 to today · last changed 2020-01-01 (R8)

Version 22 of Article A52492: in force by CMS's dates 2020-01-01 onward. The policy text on this page comes from this archived version.

DME MAC jurisdictions
JA · Noridian 16013
CT, DE, DC, ME, MD, MA, NH, NJ, NY, PA, RI, VT
JB · CGS 17013
IL, IN, KY, MI, MN, OH, WI
JC · CGS 18003
AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, PR, SC, TN, TX, VI, VA, WV
JD · Noridian 19003
AK, AS, AZ, CA, GU, HI, ID, IA, KS, MO, MT, NE, NV, ND, MP, OR, SD, UT, WA, WY
source

CMS's Who are the MACs jurisdiction pages (DME facts as of 2025-09-30) name each contractor and its states; the MCD's Contractor Information table on every DME LCD prints the contract numbers. Both read 2026-10-09. Verzi adds the state lookup only.

CMS's newest revision note (R8, 2020-01-01), quoted

Revision Effective Date: 01/01/2020 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10-CM codes Z90.02 and Z96.3 to Group 1 Codes 05/14/2026: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
source

This quote comes from CMS's revision-history file, not from the version's own file: Our archived file.

Sections in this version: Article Text. Plus 4 sections marked N/A in this version.

ICD-10-CM Codes that Support Medical Necessity (10 codes)

Group 1: 10 codes. CMS's group paragraph, quoted

The presence of an ICD-10 code listed in this section is not sufficient by itself to assure coverage. Refer to the Article Text field, Non-Medical Necessity Coverage and Payment Rules section for other coverage criteria and payment information.

ICD-10-CM Codes that DO NOT Support Medical Necessity (CMS lists no codes)

Group 1: CMS lists no codes in this group. CMS's group paragraph, quoted

All codes that are not specified in the previous section.

CMS's list for version 22. The full code table serves customers with an API key.

source

CMS's ICD-10-CM lists in the Medicare Coverage Database download, archived 2026-10-09: Our archived file.

Full verbatim text serves to customers · Customer? Log in

Version history, Article A52492

CMS numbers each version. Each box shows the version's window by CMS's stated dates. Select a version to show it on this page. Versions superseded the same day they took effect never governed a claim, so the page hides them until you ask. Version numbers CMS never published to its archive do not exist as documents.

v22015-10-01, superseded same dayv42015-10-01 to 2016-06-30v62016-07-01 to 2016-12-31v92017-01-01, superseded same dayv122017-01-01, superseded same dayv152017-01-01 to 2019-12-31v222020-01-01 to today

Revision history, every version

CMS's own change log, quoted, 6 entries. It does not change with the version shown. A revision (R-number) is a change CMS logged. The version (vN) is the snapshot that carries it.

R8 · 2020-01-01 · v22
Revision Effective Date: 01/01/2020
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Added: ICD-10-CM codes Z90.02 and Z96.3 to Group 1 Codes


05/14/2026: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R5 · 2017-01-01 · v15
02/21/2019: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This is an article and not a local coverage determination.
R4 · 2017-01-01 · v12
Revision Effective Date: 01/01/2017
 CODING GUIDELINES:
 Added: Clarification that tracheostomy tubes (A7520, A7521, 7522) are all-inclusive


04/12/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.
R3 · 2017-01-01 · v9
Revision Effective Date: 01/01/2017
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Diagnosis requirements
RELATED LOCAL COVERAGE DOCUMENTS:
Added: LCD-related Standard Documentation Requirements Language Article
R2 · 2016-07-01 · v6
Effective July 1, 2016 oversight for DME MAC Articles is the responsibility of CGS Administrators, LLC 18003 and 17013 and Noridian Healthcare Solutions, LLC 19003 and 16013. No other changes have been made to the Articles.
R1 · 2015-10-01 · v4
Revision Effective Date: 08/01/2015
NON-MEDICAL NECESSITY AND PAYMENT RULES:
Revised: Language for HCPCS codes A4450, A4452, A5120 when submitted without correct modifier
Receipts for auditors

Version 22 of Article A52492, shown on this page: in force by CMS's dates 2020-01-01 onward. Archived 2026-09-26. CMS's copy · Our archived file. 5 of 5 sections are proven word-identical to the archived file.

Every archived version of Article A52492 (9 versions, CMS's dates, window by the as-of rule).

DocumentVersionIn forceArchived onVerify
Article A52492version 22015-10-01, superseded same day2026-09-26CMS's copy · Our archived file
Article A52492version 42015-10-01 to 2016-06-302026-09-26CMS's copy · Our archived file
Article A52492version 62016-07-01 to 2016-12-312026-09-26CMS's copy · Our archived file
Article A52492version 92017-01-01, superseded same day2026-09-26CMS's copy · Our archived file
Article A52492version 122017-01-01, superseded same day2026-09-26CMS's copy · Our archived file
Article A52492version 152017-01-01 to 2019-12-312026-09-26CMS's copy · Our archived file
Article A52492version 17 no generated page2020-01-01, superseded same day2026-10-09CMS's copy · Our archived file
Article A52492version 20 no generated page2020-01-01, superseded same day2026-10-09CMS's copy · Our archived file
Article A52492version 22 shown2020-01-01 to today2026-09-26CMS's copy · Our archived file

Each archived file's page gives its sha256 fingerprint. A copy of the file hashes to the same value, byte for byte.

CMS's live page shows only the current version. To check a passage by eye, open CMS's copy of the same version number. A version's window ends on the earlier of CMS's stated end date and the day before the next version starts.

Every policy word on this page is CMS's, from the archived version named beside it. Verzi adds labels, highlights, citations and links only. Verzi-written summary content on this page: none.