A7501 HCPCS code: Tracheostoma valve, including diaphragm, each
A7501 is the HCPCS Level II code for tracheostoma valve, including diaphragm, each. The 2026 Medicare DMEPOS fee schedule pays $149.66 to $179.61 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 3 per day on DME suppliers. Medicare volume rose 183% from 2022 to 2024 (1,278 to 3,611 services). In 2024, 7 suppliers billed Medicare for A7501 (purchases), serving 392 beneficiaries; Florida, Alabama, North Carolina accounted for 40% of services. Its average fee ranks 16 of 16 A75 codes (family range $0.46–$150.23).
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 | 2001-01-01 |
| Last action effective | 2001-01-01 |
2026 Medicare DMEPOS fee schedule for A7501
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $149.66 | $179.61 | $149.66 | $127.21 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $149.66 | — |
| AL | — | $149.66 | — |
| AR | — | $149.66 | — |
| AZ | — | $149.66 | — |
| CA | — | $149.66 | — |
| CO | — | $149.66 | — |
| CT | — | $149.66 | — |
| DC | — | $149.66 | — |
| DE | — | $149.66 | — |
| FL | — | $149.66 | — |
| GA | — | $149.66 | — |
| HI | — | $149.66 | — |
| IA | — | $149.66 | — |
| ID | — | $149.66 | — |
| IL | — | $149.66 | — |
| IN | — | $149.66 | — |
| KS | — | $149.66 | — |
| KY | — | $149.66 | — |
| LA | — | $149.66 | — |
| MA | — | $149.66 | — |
| MD | — | $149.66 | — |
| ME | — | $149.66 | — |
| MI | — | $149.66 | — |
| MN | — | $149.66 | — |
| MO | — | $149.66 | — |
| MS | — | $149.66 | — |
| MT | — | $149.66 | — |
| NC | — | $149.66 | — |
| ND | — | $149.66 | — |
| NE | — | $149.66 | — |
| NH | — | $149.66 | — |
| NJ | — | $149.66 | — |
| NM | — | $149.66 | — |
| NV | — | $149.66 | — |
| NY | — | $149.66 | — |
| OH | — | $149.66 | — |
| OK | — | $149.66 | — |
| OR | — | $149.66 | — |
| PA | — | $149.66 | — |
| PR | — | $179.61 | — |
| RI | — | $149.66 | — |
| SC | — | $149.66 | — |
| SD | — | $149.66 | — |
| TN | — | $149.66 | — |
| TX | — | $149.66 | — |
| UT | — | $149.66 | — |
| VA | — | $149.66 | — |
| VI | — | $149.66 | — |
| VT | — | $149.66 | — |
| WA | — | $149.66 | — |
| WI | — | $149.66 | — |
| WV | — | $149.66 | — |
| WY | — | $149.66 | — |
How the A7501 fee compares
| Measure | Value |
|---|---|
| Rank among 16 A75 codes (lowest = 1) | 16 |
| Family fee range (average of state fees) | $0.46–$150.23 |
| Rural fee uplift | — |
Who bills A7501 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 7 |
| Referring clinicians | 291 |
| Medicare beneficiaries | 392 |
| States with claims | 22 |
| Share of services in top 3 states (Florida, Alabama, North Carolina) | 40% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 11 | 389 |
| 2023 | 6 | 346 |
| 2024 | 7 | 392 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A7501, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,278 | 389 | $123.88 | $94.09 |
| 2023 | 2,805 | 346 | $49.78 | $38.16 |
| 2024 | 3,611 | 392 | $45.28 | $34.51 |
States with the most A7501 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 653 | $16.51 |
| Alabama | 342 | $6.84 |
| North Carolina | 303 | $24.66 |
| Illinois | 269 | $25.05 |
| Texas | 269 | $48.63 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 3 | Published Contractor Policy |
| outpatient hospital claims | 1 | Nature of Equipment |
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
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 A7501
- 2026-01-01: Average state fee rose 2.0%: $147.28 to $150.23
- 2001-01-01: A7501 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 A7501?
A7501 is the HCPCS Level II code for tracheostoma valve, including diaphragm, each. Short descriptor: "Tracheostoma valve w diaphra".
How much does Medicare pay for A7501?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $149.66–$179.61. Rural fees can be higher.
Does Medicare cover A7501?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A7501?
Medicare policy articles that cite A7501 list 10 covered ICD-10-CM diagnosis codes across 1 article. 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 A7501 change in 2026?
The average non-rural state fee moved from $147.28 in 2025 to $150.23 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A7501 can be billed per day?
3 on DME suppliers; 1 on outpatient hospital claims (NCCI medically unlikely edits).
Related A75 codes
- A7502 — Replacement diaphragm/faceplate for tracheostoma valve, each ($71.15–$85.36)
- A7503 — Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each ($16.17–$19.42)
- A7504 — Filter for use in a tracheostoma heat and moisture exchange system, each ($0.97–$1.15)
- A7505 — Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each ($6.68–$7.99)
- A7506 — Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, any type each ($0.46–$0.52)
- A7507 — Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each ($3.56–$4.34)
- A7508 — Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each ($4.09–$4.95)
- A7509 — Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each ($2.01–$2.37)
- A7520 — Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each ($67.66–$81.18)
- A7521 — Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each ($67.04–$80.49)
- A7522 — Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and reusable), each ($64.36–$77.22)
- A7523 — Tracheostomy shower protector, each
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 A7501
- Watch A7501 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A7501
Sources: CMS HCPCS Level II release October 2026; 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.