GASTRIC SUCTION
A gastric suction pump is used to remove gastrointestinal fluids under continuous or intermittent suction via a tube. Use of a gastric suction pump and related supplies are covered for beneficiaries who are unable to empty gastric secretions through normal gastrointestinal functions. Use of a gastric suction pump for other conditions will be denied as not reasonable and necessary.
Supplies (tubing, tape, dressings, etc.) are covered and are separately payable when they are medically necessary and used with a medically necessary E2000 pump. Supplies used with DME that is denied as not reasonable and necessary will also be denied as not reasonable and necessary.
RESPIRATORY SUCTION
A respiratory suction pump is only covered for beneficiaries who have difficulty raising and clearing secretions secondary to:
1. Cancer or surgery of the throat or mouth
2. Dysfunction of the swallowing muscles
3. Unconsciousness or obtunded state
4. Tracheostomy
Use of a respiratory suction pump for other conditions will be denied as not reasonable and necessary.
Suction catheters and sterile water/saline are covered and are separately payable when they are medically necessary and used with a medically necessary pump. Supplies used with DME that is denied as not reasonable and necessary will also be denied as not reasonable and necessary.
Certain catheters are only covered for beneficiaries with a tracheostomy. Patient must have a tracheostomy ICD-10 code.
· Tracheal suction catheters are reasonable and necessary only when all of the following are met:
o The beneficiary has a tracheostomy.
o The beneficiary requires the use of a covered respiratory suction pump as described above, for tracheostomy suctioning.
· Closed system catheters are reasonable and necessary only when all of the following are met:
o The beneficiary has a tracheostomy.
o The beneficiary requires the use of a covered respiratory suction pump as described above, for tracheostomy suctioning.
o The beneficiary requires the use of a covered ventilator. (Refer to CMS’ Internet Only Manual 100-03, CH 1, §280.1 for information about the coverage of ventilators.)
More than three catheters per day will be denied as not reasonable and necessary for tracheostomy suctioning.
Non-tracheal suction catheters are reasonable and necessary for suctioning in the oropharynx. The oropharynx is not sterile, therefore the catheter can be reused if properly cleansed and/or disinfected. More than three catheters per week will be denied as not reasonable and necessary for oropharyngeal suctioning.
Sterile water/saline solution is covered when used to clear a suction catheter after tracheostomy suctioning. Sterile water/saline will be denied as not reasonable and necessary when used for oropharyngeal suctioning.