A4625 HCPCS code: Tracheostomy care kit for new tracheostomy
A4625 is the HCPCS Level II code for tracheostomy care kit for new tracheostomy. The 2026 Medicare DMEPOS fee schedule pays $8.39 to $63.09 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 100 per day on DME suppliers. Medicare volume fell 7% from 2022 to 2024 (7,831 to 7,315 services). In 2024, 141 suppliers billed Medicare for A4625 (purchases), serving 227 beneficiaries; Texas, Georgia, Ohio accounted for 39% of services. Its average fee ranks 8 of 10 A46 codes (family range $0.08–$71.71).
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 37 — DMEPOS: ostomy, tracheostomy and urological supplies |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1990-01-01 |
| Last action effective | 2003-01-01 |
2026 Medicare DMEPOS fee schedule for A4625
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $8.39 | $63.09 | $9.87 | $8.39 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $8.82 | — |
| AL | — | $9.87 | — |
| AR | — | $9.87 | — |
| AZ | — | $9.39 | — |
| CA | — | $8.72 | — |
| CO | — | $9.87 | — |
| CT | — | $9.87 | — |
| DC | — | $9.87 | — |
| DE | — | $9.87 | — |
| FL | — | $9.87 | — |
| GA | — | $9.87 | — |
| HI | — | $9.44 | — |
| IA | — | $8.39 | — |
| ID | — | $8.39 | — |
| IL | — | $9.22 | — |
| IN | — | $8.39 | — |
| KS | — | $9.67 | — |
| KY | — | $9.87 | — |
| LA | — | $9.87 | — |
| MA | — | $8.39 | — |
| MD | — | $9.87 | — |
| ME | — | $8.39 | — |
| MI | — | $9.87 | — |
| MN | — | $9.87 | — |
| MO | — | $8.39 | — |
| MS | — | $8.39 | — |
| MT | — | $9.87 | — |
| NC | — | $8.39 | — |
| ND | — | $8.39 | — |
| NE | — | $9.67 | — |
| NH | — | $8.39 | — |
| NJ | — | $9.87 | — |
| NM | — | $9.87 | — |
| NV | — | $9.39 | — |
| NY | — | $9.87 | — |
| OH | — | $9.87 | — |
| OK | — | $9.87 | — |
| OR | — | $8.39 | — |
| PA | — | $9.87 | — |
| PR | — | $63.09 | — |
| RI | — | $9.52 | — |
| SC | — | $8.39 | — |
| SD | — | $8.39 | — |
| TN | — | $8.39 | — |
| TX | — | $9.87 | — |
| UT | — | $9.87 | — |
| VA | — | $9.87 | — |
| VI | — | $9.87 | — |
| VT | — | $8.39 | — |
| WA | — | $9.31 | — |
| WI | — | $9.87 | — |
| WV | — | $9.87 | — |
| WY | — | $8.39 | — |
How the A4625 fee compares
| Measure | Value |
|---|---|
| Rank among 10 A46 codes (lowest = 1) | 8 |
| Family fee range (average of state fees) | $0.08–$71.71 |
| Rural fee uplift | — |
Who bills A4625 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 141 |
| Referring clinicians | 215 |
| Medicare beneficiaries | 227 |
| States with claims | 13 |
| Share of services in top 3 states (Texas, Georgia, Ohio) | 39% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 110 | 193 |
| 2023 | 137 | 241 |
| 2024 | 141 | 227 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A4625, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 7,831 | 193 | $8.53 | $6.61 |
| 2023 | 7,496 | 241 | $9.35 | $7.25 |
| 2024 | 7,315 | 227 | $9.25 | $7.02 |
States with the most A4625 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 899 | $6.93 |
| Georgia | 749 | $7.22 |
| Ohio | 597 | $6.62 |
| Illinois | 543 | $6.92 |
| North Carolina | 489 | $6.21 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 100 | Published Contractor Policy |
| outpatient hospital claims | 30 | Published Contractor Policy |
| practitioner claims | 30 | Published Contractor Policy |
Medicare policy articles for this code
- A52492: Tracheostomy Care Supplies - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- A54563: Surgical Dressings - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (10 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| J95.00 | Unspecified tracheostomy complication | 1 |
| J95.01 | Hemorrhage from tracheostomy stoma | 1 |
| J95.02 | Infection of tracheostomy stoma | 1 |
| J95.03 | Malfunction of tracheostomy stoma | 1 |
| J95.04 | Tracheo-esophageal fistula following tracheostomy | 1 |
| J95.09 | Other tracheostomy complication | 1 |
| Z43.0 | Encounter for attention to tracheostomy | 1 |
| Z90.02 | Acquired absence of larynx | 1 |
| Z93.0 | Tracheostomy status | 1 |
| Z96.3 | Presence of artificial larynx | 1 |
What changed for A4625
- 2026-01-01: Average state fee rose 2.0%: $10.12 to $10.32
- 1990-01-01: A4625 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code A4625?
A4625 is the HCPCS Level II code for tracheostomy care kit for new tracheostomy. Short descriptor: "Trach care kit for new trach".
How much does Medicare pay for A4625?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $8.39–$63.09. Rural fees can be higher.
Does Medicare cover A4625?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A4625?
Medicare policy articles that cite A4625 list 10 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include J95.00 (Unspecified tracheostomy complication), J95.01 (Hemorrhage from tracheostomy stoma), J95.02 (Infection of tracheostomy stoma). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for A4625 change in 2026?
The average non-rural state fee moved from $10.12 in 2025 to $10.32 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A4625 can be billed per day?
100 on DME suppliers; 30 on outpatient hospital claims; 30 on practitioner claims (NCCI medically unlikely edits).
Related A46 codes
- A4600 — Sleeve for intermittent limb compression device, replacement only, each
- A4601 — Lithium ion battery, rechargeable, for non-prosthetic use, replacement
- A4602 — Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each ($5.31–$6.33)
- A4604 — Tubing with integrated heating element for use with positive airway pressure device ($49.31–$76.79)
- A4605 — Tracheal suction catheter, closed system, each ($23.31–$27.99)
- A4606 — Oxygen probe for use with oximeter device, replacement
- A4608 — Transtracheal oxygen catheter, each ($71.44–$85.73)
- A4611 — Battery, heavy duty; replacement for patient owned ventilator
- A4612 — Battery cables; replacement for patient-owned ventilator
- A4613 — Battery charger; replacement for patient-owned ventilator
- A4614 — Peak expiratory flow rate meter, hand held ($33.89–$40.68)
- A4615 — Cannula, nasal ($1.04–$1.25)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under A4625
- Watch A4625 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4625
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.