A7521 HCPCS code: Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each
A7521 is the HCPCS Level II code for tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each. The 2026 Medicare DMEPOS fee schedule pays $67.04 to $80.49 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on DME suppliers. Medicare volume rose 2% from 2022 to 2024 (11,445 to 11,689 services). In 2024, 779 suppliers billed Medicare for A7521 (purchases), serving 4,695 beneficiaries; New York, California, Texas accounted for 31% of services. Its average fee ranks 12 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 | C — Carrier judgment |
| Pricing indicator | 37 — DMEPOS: ostomy, tracheostomy and urological supplies |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 2004-01-01 |
| Last action effective | 2004-01-01 |
2026 Medicare DMEPOS fee schedule for A7521
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $67.04 | $80.49 | $67.04 | $56.98 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $67.04 | — |
| AL | — | $67.04 | — |
| AR | — | $67.04 | — |
| AZ | — | $67.04 | — |
| CA | — | $67.04 | — |
| CO | — | $67.04 | — |
| CT | — | $67.04 | — |
| DC | — | $67.04 | — |
| DE | — | $67.04 | — |
| FL | — | $67.04 | — |
| GA | — | $67.04 | — |
| HI | — | $67.04 | — |
| IA | — | $67.04 | — |
| ID | — | $67.04 | — |
| IL | — | $67.04 | — |
| IN | — | $67.04 | — |
| KS | — | $67.04 | — |
| KY | — | $67.04 | — |
| LA | — | $67.04 | — |
| MA | — | $67.04 | — |
| MD | — | $67.04 | — |
| ME | — | $67.04 | — |
| MI | — | $67.04 | — |
| MN | — | $67.04 | — |
| MO | — | $67.04 | — |
| MS | — | $67.04 | — |
| MT | — | $67.04 | — |
| NC | — | $67.04 | — |
| ND | — | $67.04 | — |
| NE | — | $67.04 | — |
| NH | — | $67.04 | — |
| NJ | — | $67.04 | — |
| NM | — | $67.04 | — |
| NV | — | $67.04 | — |
| NY | — | $67.04 | — |
| OH | — | $67.04 | — |
| OK | — | $67.04 | — |
| OR | — | $67.04 | — |
| PA | — | $67.04 | — |
| PR | — | $80.49 | — |
| RI | — | $67.04 | — |
| SC | — | $67.04 | — |
| SD | — | $67.04 | — |
| TN | — | $67.04 | — |
| TX | — | $67.04 | — |
| UT | — | $67.04 | — |
| VA | — | $67.04 | — |
| VI | — | $67.04 | — |
| VT | — | $67.04 | — |
| WA | — | $67.04 | — |
| WI | — | $67.04 | — |
| WV | — | $67.04 | — |
| WY | — | $67.04 | — |
How the A7521 fee compares
| Measure | Value |
|---|---|
| Rank among 16 A75 codes (lowest = 1) | 12 |
| Family fee range (average of state fees) | $0.46–$150.23 |
| Rural fee uplift | — |
Who bills A7521 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 779 |
| Referring clinicians | 3,106 |
| Medicare beneficiaries | 4,695 |
| States with claims | 48 |
| Share of services in top 3 states (New York, California, Texas) | 31% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 776 | 4,795 |
| 2023 | 788 | 4,659 |
| 2024 | 779 | 4,695 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A7521, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 11,445 | 4,795 | $57.46 | $44.41 |
| 2023 | 11,469 | 4,659 | $62.34 | $48.05 |
| 2024 | 11,689 | 4,695 | $63.97 | $49.27 |
States with the most A7521 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New York | 1,877 | $49.67 |
| California | 998 | $49.29 |
| Texas | 778 | $48.33 |
| Minnesota | 741 | $49.65 |
| Pennsylvania | 619 | $49.43 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | 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 A7521
- 2026-01-01: Average state fee rose 2.0%: $65.98 to $67.29
- 2004-01-01: A7521 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 A7521?
A7521 is the HCPCS Level II code for tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each. Short descriptor: "Trach/laryn tube cuffed".
How much does Medicare pay for A7521?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $67.04–$80.49. Rural fees can be higher.
Does Medicare cover A7521?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for A7521?
Medicare policy articles that cite A7521 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 A7521 change in 2026?
The average non-rural state fee moved from $65.98 in 2025 to $67.29 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A7521 can be billed per day?
1 on DME suppliers; 1 on outpatient hospital claims (NCCI medically unlikely edits).
Related A75 codes
- A7501 — Tracheostoma valve, including diaphragm, each ($149.66–$179.61)
- 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)
- 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 A7521
- Watch A7521 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A7521
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.