HCPCS code A4625 – Care kit for a new tracheostomy

Key takeaways

HCPCS Code A4625 is the tracheostomy care kit for a new tracheostomy, billed only in the first two postoperative weeks after an open surgical tracheostomy.

From the third postoperative week onward, bill A4629, the care kit for an established tracheostomy. The two codes never share a date of service.

No Certificate of Medical Necessity (CMN) is required. A Standard Written Order (SWO) must reach the supplier before the claim is submitted, and proof of delivery is needed.

Claims management software such as Pabau keeps each claim beside the patient record. The billing team can check the procedure date before a kit claim goes out.

What is HCPCS Code A4625?

HCPCS Code A4625 is the Level II code for a tracheostomy care kit for a new tracheostomy. CMS describes it as a starter kit.

It covers the cleaning supplies a patient needs in the first two postoperative weeks after an open surgical tracheostomy.

The word “new” in the descriptor sets a hard time limit. CMS Policy Article A52492 codes any care kit supplied in the first two postoperative weeks as A4625. From the third week onward, the kit is billed as A4629, the care kit for an established tracheostomy.

The Local Coverage Determination (LCD) for tracheostomy care supplies, L33832, states that A4625 is no longer medically necessary beginning two weeks after surgery. A4625 therefore covers a short starter phase, and ongoing kit supply moves to A4629.

What does an A4625 starter kit contain?

CMS Policy Article A52492 lists the contents of an A4625 starter kit. The kit is billed as one unit, and its components are not billed separately.

• 1 plastic tray
• 1 basin
• 1 pair of sterile gloves
• 1 tube brush
• 3 pipe cleaners
• 1 pre-cut tracheostomy dressing
• 1 roll of gauze
• 4 sponges (4×4)
• 2 cotton-tip applicators
• 30 inches of twill tape

The established-tracheostomy kit, A4629, is smaller. It holds a tube brush, two pipe cleaners, two cotton-tip applicators, 30 inches of twill tape, and two 4×4 sponges. The tray, basin, sterile gloves, dressing, and gauze roll come only in the starter kit.

Suction catheters, inner cannulas, and tracheostomy tubes sit outside both kits. Bill them under their own codes, such as A4624 for a tracheal suction catheter or A4623 for an inner cannula.

A4625 vs. A4629: New versus established tracheostomy

A4625 and A4629 describe the same kind of item, and timing alone decides which code applies. The patient’s clinical stability doesn’t change the code. Count from the date of the open surgical tracheostomy.

Record the tracheostomy procedure date in the patient file before the first kit ships. An A4625 claim for a kit supplied after week two risks a medical necessity denial. An A4629 claim inside the window fails the same way. The chart below maps both codes to the postoperative calendar, with what each kit holds.

For the rules that apply from week three, see our guide to HCPCS Code A4629.

Medicare coverage for A4625

Medicare Part B covers A4625 under the DMEPOS benefit after an open surgical tracheostomy. LCD L33832 requires that the tracheostomy has been open, or is expected to remain open, for at least three months.

Coverage of the starter kit ends two weeks after surgery. Policy Article A52492 also requires a diagnosis code that justifies the kit on each claim. DME MACs can add local requirements, so check your contractor’s guidance before billing.

Coverage rules differ by payer type.

When Medicare and a secondary payer are both active, knowing the payer order prevents duplicate billing. Our guide to medical billing covers that in more depth.

ICD-10-CM codes that support A4625

Every A4625 claim needs an ICD-10-CM code that justifies the kit. The table below lists codes named in Policy Article A52492.

The policy article also covers the specific tracheostomy complication codes J95.01 through J95.04. Verify the diagnosis against the current LCD and policy article before billing. Both are revised periodically, and a code that supported a claim last year may need more documentation now.

How to bill HCPCS Code A4625: Step-by-step

Billing A4625 correctly takes five steps, in order. Skipping one is the most direct path to a denial or audit exposure.

1. Confirm eligibility and coverage. Run insurance eligibility verification before dispensing the kit. Confirm the beneficiary is enrolled in Medicare Part B. For Medicaid or commercial payers, check whether prior authorization is required.
2. Confirm the billing window. Check the tracheostomy procedure date in the record. Bill A4625 only for kits supplied in the first two postoperative weeks, and switch to A4629 from week three.
3. Confirm the Standard Written Order is on file. The SWO must reach the supplier before the claim is submitted. Best practice is to hold it before the kit ships. No Certificate of Medical Necessity is needed.
4. Link a supporting ICD-10-CM code. Select the diagnosis that best reflects the documented reason for the tracheostomy. Use a J95 code when a complication drives the need.
5. Submit to the right DME MAC. DMEPOS claims route to the DME MAC covering the beneficiary’s home address, not the supplier’s location. Box 21 of the CMS-1500 carries the ICD-10-CM code, and Box 24D carries A4625. For submitting a clean claim, confirm every required field before transmission.

Pabau, the practice management platform we build, includes claims management software for HCPCS supply billing. It helps practices track documentation status, manage payer-specific rules, and catch claim errors before submission.

Modifiers used with HCPCS Code A4625

Modifier rules for A4625 come from your DME MAC and general DMEPOS billing rules. The four modifiers below appear most often on supply claims.

A kit supplied after week two should be billed as A4629, not as A4625 with a GA or GZ modifier. Confirm your DME MAC’s current modifier guidance before submitting.

A4625 fee schedule and reimbursement

Medicare pays A4625 under the DMEPOS fee schedule, which CMS updates each year. Rates vary by state, so a single national figure won’t match your allowable.

Check the current amount in the CMS DMEPOS fee schedule files or your DME MAC’s fee schedule portal. Treat figures from third-party aggregators as estimates, since they can lag behind CMS updates.

Required documentation for A4625 reimbursement

Incomplete documentation drives many A4625 post-payment audits. DME MACs can recoup payments made without supporting records. Assemble the file before the kit ships, not after a request for additional documentation arrives.

No Certificate of Medical Necessity (CMN) is required for A4625. The file needs these records instead.

• Standard Written Order (SWO): a signed order for the kit, received by the supplier before the claim is submitted
• Tracheostomy procedure date: an operative report or clinical note showing the kit falls inside the first two postoperative weeks
• Duration expectation: documentation that the tracheostomy has been open, or is expected to remain open, for at least three months
• Diagnosis code: an ICD-10-CM code on the claim that justifies the kit
• Proof of delivery: signed delivery documentation showing the beneficiary or an authorized representative received the kit on the billed date

Keep these records where an auditor can reach them quickly. Good medical billing compliance means storing the order, procedure date, and delivery receipt as one linked file for each kit.

A4625 and related tracheostomy supply codes

Tracheostomy supply codes share similar descriptors and serve the same patients, so picking the wrong one is a common billing error. The table below shows when A4625 applies and when a neighboring code does.

Bundling rules decide which codes can share a date of service. A4625 and A4629 never appear together for the same patient on the same date. Billing kit components such as gauze or twill tape alongside A4625 counts as unbundling. Check current edits in the CMS HCPCS overview resources and your DME MAC’s guidance before co-billing.

Common denial reasons for HCPCS Code A4625 and how to resolve them

A4625 denials follow predictable patterns. Use our denial codes reference to match remittance codes to the resolution steps below.

Effective denial management in healthcare for DMEPOS claims means tracking each A4625 denial by reason code. Recurring patterns then show up at a glance rather than claim by claim.

How Pabau supports accurate A4625 billing

Most A4625 errors start with a date nobody checked. The surgery date sits in a discharge note, the order arrives separately, and the claim gets built in a billing tool that sees neither.

Pabau holds patient records, digital forms, and invoicing in one system. The billing team can see the procedure date and the signed order on the patient file before a kit claim goes out.

Reporting then shows which claims denied and why. A run of late starter-kit claims gets fixed at intake, instead of one appeal at a time.

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Conclusion

A4625 is a two-week code, and every rule around it follows from the procedure date. The starter kit covers weeks one and two, A4629 takes over from week three, and the two never share a date.

Capture that date before the first kit ships, and get the Standard Written Order on file before the claim goes out. With the date, the order and a signed delivery receipt in place, the claim holds up to review. The switch to A4629 then happens on schedule.

Book a demo to see how Pabau keeps the procedure date, the order, and the claim together for tracheostomy supply billing.

Continue your research

Billing the kit from week three? HCPCS Code A4629 covers the established-tracheostomy kit, its contents and its documentation rules.

Supplying a cleaning brush on its own? HCPCS Code A4626 explains when a tracheostomy cleaning brush is billed as a separate item.

Need to understand how denials are categorized across claim types? Denial codes in medical billing breaks down the most common remittance advice reason codes and corrective actions.

Want to reduce claim errors before submission? Submitting a clean claim covers the field-level requirements that prevent the most frequent DMEPOS rejections.

Looking to build a stronger billing compliance program? Medical billing compliance outlines the documentation and audit-readiness standards that apply across supply code billing.

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