HCPCS code A4623 – Tracheostomy inner cannula billing guide

Key takeaways

HCPCS Code A4623 covers a tracheostomy inner cannula only, not care kits or outer tubes.

Medicare covers A4623 as a prosthetic supply under LCD L33832 when an enrolled DMEPOS supplier bills it and the record supports medical necessity.

No KX modifier is required for A4623, and GA applies only when a signed Advance Beneficiary Notice is on file.

Insufficient documentation, including missing refill orders and patient confirmation of need, is the leading cause of improper tracheostomy-supply payments.

Pabau, an all-in-one practice management system, keeps orders, refill confirmations and delivery records on one patient record before a claim goes out.

HCPCS Code A4623: official description and key details

HCPCS Code A4623 carries the official descriptor “Tracheostomy, inner cannula” in the CMS HCPCS Level II code file. It covers the inner cannula only, not tracheostomy care kits or the outer tube. Medicare Part B pays for it as a prosthetic supply, billed by an enrolled DMEPOS supplier.

The billing unit is “each,” so a supplier dispensing three inner cannulas in a month bills three units of A4623. Those units are checked against the usual maximum quantities in LCD L33832. Understanding the medical billing workflow for DMEPOS claims is the starting point for avoiding the denials that affect this code most often.

What A4623 covers and what it does not

A4623 covers tracheostomy inner cannulas dispensed to a patient with a tracheostomy. The inner cannula is the removable tube that fits inside the outer tracheostomy tube. It is taken out, cleaned or replaced, and reinserted as part of routine tracheostomy care.

Included under A4623:

• Inner cannulas designed to fit a tracheostomy tube already in place
• Replacement inner cannulas provided to a patient at home or in a non-facility setting
• Inner cannulas dispensed as a stand-alone supply (not part of a tracheostomy care kit)

Not covered under A4623:

• The full outer tracheostomy tube (billed under a separate code)
• Tracheostomy care kits for a new tracheostomy (see A4625)
• Tracheostomy care kits for an established tracheostomy (see A4629)
• Tracheal suction catheters (see A4624, or A4605 for closed-system catheters)
• Tracheostomy cleaning brushes (see A4626)

LCD L33832 covers tracheostomy supplies when the patient has a tracheostomy and the supplies are medically necessary for ongoing airway care. Check the AAPC HCPCS Level II code lookup to confirm the current descriptor before submitting.

Medicare coverage and LCD L33832 requirements

Medicare Part B covers HCPCS Code A4623 under the prosthetic benefit (Social Security Act §1861(s)(8)) when LCD L33832 is met. Its policy article, Article A52492, sets the coding and billing rules. Coverage depends on the following criteria.

• Existing tracheostomy: The beneficiary must have a documented tracheostomy. An order for inner cannulas placed before the tracheostomy is confirmed in the record does not meet coverage criteria.
• Enrolled DMEPOS supplier: Claims must come from a supplier with an active DMEPOS enrollment with Medicare. Physicians who dispense the item themselves need that enrollment to bill it.
• Medical necessity: The patient’s condition must require ongoing tracheostomy care. The record should show why home replacement inner cannulas are needed and note any patient or caregiver training.
• Supporting diagnosis: Article A52492 lists the ICD-10-CM codes that support coverage: J95.00-J95.09, Z43.0, Z90.02, Z93.0 and Z96.3. A listed code alone does not guarantee payment.
• DME MAC jurisdiction: L33832 is a DME MAC policy, so the same LCD and article apply in every jurisdiction. Send the claim to the DME MAC that serves the beneficiary’s home state.

Medicare pays for A4623 as a purchased supply, not as a capped rental. The DMEPOS supplier submits the claim on a CMS-1500 or 837P electronic transaction, not on a facility claim. Place of service is typically 12 (Home) when the beneficiary receives the supplies at their residence.

Documentation requirements for A4623

Strong documentation is the primary defense against denial for HCPCS Code A4623. The medical record must support both the tracheostomy and the ongoing need for replacement inner cannulas.

Required elements include:

• Physician order: A written or electronic order from the treating physician naming the item (tracheostomy inner cannula), the quantity, and how often it is replaced. The order must be signed and dated before the claim is submitted.
• Diagnosis code on every claim: A diagnosis that explains why the patient has a tracheostomy and needs ongoing care. The ICD-10-CM code on the claim should match the condition documented in the record.
• Evidence of tracheostomy: An operative report, hospital discharge summary, or clinical note confirming the tracheostomy is present.
• Refill order and confirmation of need: For each refill, a record that the beneficiary or caregiver confirmed they still need the supply before it shipped.
• Face-to-face encounter and written order before delivery: Both are needed first when the item is on the CMS Final Rule 1713 list. A written order obtained after delivery does not make the item payable.
• Proof of delivery: Confirmation that the item reached the beneficiary, including their signature where required.

Keeping these records complete supports medical billing compliance and reduces the risk of post-payment audits. Suppliers should retain all documentation for at least seven years in line with Medicare’s record-keeping requirements.

Billing guidelines and replacement frequency for HCPCS Code A4623

Billing HCPCS Code A4623 correctly depends on the right modifiers, the correct place of service, and the quantity you dispense. LCD L33832 is the same in every DME MAC jurisdiction, and Article A52492 is its policy article.

The LCD’s usual maximum quantities are a guideline, not a hard cap. Units above them are denied only when the medical record does not explain why the patient needs more. Suppliers also cannot dispense more than a 3-month supply at home, or a 1-month supply to a patient in a nursing facility.

Common modifiers for A4623

Neither LCD L33832 nor Article A52492 requires the KX modifier on A4623. The policy names one modifier, AU, and it goes on tape and skin barrier wipes (A4450, A4452, A5120) billed with tracheostomy supplies. Add GA only when the beneficiary has signed an Advance Beneficiary Notice (ABN). NU and UE are general DME modifiers, not requirements of this policy.

Place of service and home vs. facility billing

A4623 is almost always billed with place of service 12 (Home) when the beneficiary receives supplies at their residence. During a Part A skilled nursing facility (SNF) stay, the inner cannula is generally bundled into the SNF per diem. It cannot be billed separately to Part B then, and doing so is a common error that triggers recovery audits.

A4623 vs. related tracheostomy codes: how to choose

Several HCPCS codes cover tracheostomy supplies, and they are easy to mix up. The table below separates A4623 from the codes most often confused with it.

The A4623 vs. A4629 choice causes the most confusion. A4629 is a site-care kit for an established tracheostomy, and it does not contain an inner cannula. A cleaning brush (A4626) supplied with either kit is included in the kit allowance.

Article A52492 says kit quantities cover all site care, so extra kit items are not billable for site care. A replacement inner cannula is a separate item. Bill it under A4623 with its own documented need, alongside A4629 when both were dispensed. The chart below matches each item to its code.

Common claim denial reasons and how to avoid them

HCPCS Code A4623 claims are denied for predictable, avoidable reasons. Most come down to paperwork or code selection rather than a lack of medical necessity. Each denial arrives with a reason code, and our guide to medical billing denial codes explains how to read them.

• Insufficient documentation: The leading cause. CMS attributes 55.9% of improper tracheostomy-supply payments to it, including missing refill orders and patient confirmation of need. Orders must be signed and dated before the date of service.
• Quantity above the usual maximum: LCD L33832 lists usual maximum quantities. Units above them are denied only when the record does not explain the extra need.
• Diagnosis does not support coverage: The claim needs an ICD-10-CM code that explains the tracheostomy, such as Z93.0, Z43.0, Z90.02, Z96.3 or J95.00-J95.09. A generic or unrelated code fails the medical necessity check.
• Supplier not enrolled as DMEPOS: Only an enrolled DMEPOS supplier can bill A4623 to Medicare Part B. Claims from non-enrolled entities are rejected at intake.
• Billing a cannula as site care: The kits A4625 and A4629 cover site care, and extra kit items for site care are not billable. A replacement cannula billed under A4623 needs its own documented need.
• Billing during a Part A SNF stay: Inner cannulas furnished during a covered Part A SNF stay are bundled into the SNF per diem. They cannot be billed separately to Part B.

Effective denial management strategies for DMEPOS suppliers start with pre-submission checks that catch missing records, quantity overruns, and diagnosis mismatches. The CMS tracheostomy supplies compliance tips list the documentation errors reviewers find most often. Review the PGM Billing HCPCS lookup tool to cross-reference the current code status.

2026 fee schedule and reimbursement rates for A4623

Medicare pays for HCPCS Code A4623 as a purchased DMEPOS supply at a fee schedule rate that CMS updates every year. The 2026 rates are in the CMS DMEPOS fee schedule files. Rates vary by state and change each year, so this article does not quote a dollar amount. Pull the current rate from the CMS file for your fee schedule area.

How reimbursement is structured

Private payers typically reimburse A4623 at a rate negotiated with the DMEPOS supplier. Some set it as a percentage of the Medicare allowable, while others use their own fee schedule. Check the payer contract for non-Medicare claims rather than assuming the Medicare rate applies. Our guide to submitting a clean claim covers the technical rejections that delay payment.

How Pabau keeps A4623 claims complete before they go out

CMS ties most improper tracheostomy-supply payments to paperwork. An order sits unsigned, a refill goes out without the patient’s confirmation, or a delivery slip never gets filed. When those records live in email threads and paper folders, the claim leaves before anyone spots the missing piece.

Pabau, the all-in-one practice management system we build, keeps the order, diagnosis, forms and notes on one patient record. Its claims management software pulls that data into a pre-filled claim. It then submits and tracks the claim through Claim.MD in the US.

Your team checks one record before billing, instead of searching three systems after a denial lands.

Keep every A4623 claim fully documented

Pabau keeps orders, refill confirmations and delivery records on one patient record. Its claims management pulls that data into the claim, so fewer A4623 claims come back for paperwork.

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Conclusion

HCPCS Code A4623 is simple to code and easy to get denied. The risk sits in the records around it: the order, the refill confirmation, the proof of delivery, and the diagnosis on the claim. Each of those can be checked before the claim goes out.

Bill the cannula on its own documented need rather than treating it as part of a kit. Quantities above the usual maximum are payable when the record explains them, so write that explanation before you bill.

Want tracheostomy supply orders, refill confirmations and delivery records on one patient record before you bill? Book a demo to see how Pabau handles it.

Continue your research

Need a framework for reducing DMEPOS claim rejections? Denial management in healthcare walks through the root-cause categories that drive the highest rejection rates.

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Want to understand the full revenue cycle behind a DMEPOS claim? What is revenue cycle management explains how each step from order to payment connects.

Coding suction supplies on the same order? HCPCS Code A4624 explains when an open-system suction catheter is billable.

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