J95.00: Unspecified tracheostomy complication
J95.00, unspecified tracheostomy complication, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 42 HCPCS Level II codes, including A7047 (Oral interface used with respiratory suction pump, each), E0600 (Respiratory suction pump, home model, portable or…), E2000 (Gastric suction pump, home model, portable or stationary…). 28 of these codes have a 2026 DMEPOS fee schedule amount; A7047 pays $172.31 to $206.76 (NU) depending on the state. The articles come from 2 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with J95.00 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| A7047 | Oral interface used with respiratory suction pump, each | Carrier judgment | $172.31–$206.76 (NU) | 1 |
| E0600 | Respiratory suction pump, home model, portable or stationary, electric | Special coverage instructions apply | $55.46–$96.87 (RR) | 1 |
| E2000 | Gastric suction pump, home model, portable or stationary, electric | Carrier judgment | $62.79–$86.61 (RR) | 1 |
| A4605 | Tracheal suction catheter, closed system, each | Carrier judgment | $23.31–$27.99 (NU) | 1 |
| A7000 | Canister, disposable, used with suction pump, each | Carrier judgment | $9.24–$13.39 (NU) | 1 |
| A4628 | Oral and/or oropharyngeal suction catheter, each | Carrier judgment | $5.20–$6.27 (NU) | 1 |
| A7002 | Tubing, used with suction pump, each | Carrier judgment | $3.87–$5.47 (NU) | 1 |
| A4217 | Sterile water/saline, 500 ml | Special coverage instructions apply | $2.18–$4.93 | 1 |
| A4624 | Tracheal suction catheter, any type other than closed system, each | Carrier judgment | $1.75–$4.21 (NU) | 1 |
| A4216 | Sterile water, saline and/or dextrose, diluent/flush, 10 ml | Special coverage instructions apply | $0.53–$0.99 | 1 |
| E0486 | Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment | Carrier judgment | — | 1 |
| A9272 | Wound suction, disposable, includes dressing, all accessories and components, any type, each | Special coverage instructions apply | — | 1 |
| E0485 | Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment | Carrier judgment | — | 1 |
| K0743 | Suction pump, home model, portable, for use on wounds | Carrier judgment | — | 1 |
| K0744 | Absorptive wound dressing for use with suction pump, home model, portable, pad size 16 square inches or less | Carrier judgment | — | 1 |
| K0745 | Absorptive wound dressing for use with suction pump, home model, portable, pad size more than 16 square inches but less than or equal to 48 square inches | Carrier judgment | — | 1 |
| K0746 | Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 square inches | Carrier judgment | — | 1 |
| A7501 | Tracheostoma valve, including diaphragm, each | Special coverage instructions apply | $149.66–$179.61 | 1 |
| A7520 | Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each | Carrier judgment | $67.66–$81.18 | 1 |
| A7521 | Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each | Carrier judgment | $67.04–$80.49 | 1 |
| A7522 | Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and reusable), each | Carrier judgment | $64.36–$77.22 | 1 |
| A4625 | Tracheostomy care kit for new tracheostomy | Special coverage instructions apply | $8.39–$63.09 | 1 |
| A7503 | Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each | Special coverage instructions apply | $16.17–$19.42 | 1 |
| A4629 | Tracheostomy care kit for established tracheostomy | Special coverage instructions apply | $6.59–$7.73 | 1 |
| A7526 | Tracheostomy tube collar/holder, each | Carrier judgment | $4.83–$5.71 | 1 |
17 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing J95.00
- A52519: Suction Pumps - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 18 Level II codes). LCD with the same title: L33612
- A52492: Tracheostomy Care Supplies - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 21 Level II codes). LCD with the same title: L33832
- A56717: Billing and Coding: Respiratory Therapy (Respiratory Care) (Palmetto GBA (MAC - Part A); 3 Level II codes). LCD with the same title: L34430
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other J95 diagnoses (Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified)
- J95.01 — Hemorrhage from tracheostomy stoma
- J95.02 — Infection of tracheostomy stoma
- J95.03 — Malfunction of tracheostomy stoma
- J95.04 — Tracheo-esophageal fistula following tracheostomy
- J95.09 — Other tracheostomy complication
- J95.1 — Acute pulmonary insufficiency following thoracic surgery
- J95.2 — Acute pulmonary insufficiency following nonthoracic surgery
- J95.3 — Chronic pulmonary insufficiency following surgery
- J95.821 — Acute postprocedural respiratory failure
- J95.822 — Acute and chronic postprocedural respiratory failure
- J95.84 — Transfusion-related acute lung injury (TRALI)
- J95.860 — Postprocedural hematoma of a respiratory system organ or structure…
- J95.861 — Postprocedural hematoma of a respiratory system organ or structure…
- J95.862 — Postprocedural seroma of a respiratory system organ or structure…
- J95.863 — Postprocedural seroma of a respiratory system organ or structure…
Frequently asked questions
Does Medicare cover J95.00 (Unspecified tracheostomy complication)?
Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list J95.00 as a covered diagnosis for 42 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 J95.00?
The Level II codes from the policies most specific to this diagnosis are A7047 (Oral interface used with respiratory suction pump, each, 1 article); E0600 (Respiratory suction pump, home model, portable or…, 1 article); E2000 (Gastric suction pump, home model, portable or stationary…, 1 article); A4605 (Tracheal suction catheter, closed system, each, 1 article); A7000 (Canister, disposable, used with suction pump, each, 1 article). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with J95.00?
Under the 2026 DMEPOS fee schedule (non-rural state fees): A7047 $172.31 to $206.76 (NU); E0600 $55.46 to $96.87 (RR); E2000 $62.79 to $86.61 (RR); A4605 $23.31 to $27.99 (NU). Medicare pays 80% of the allowed amount after the Part B deductible.
Which Medicare policy articles list J95.00?
A52519 (Suction Pumps - Policy Article); A52492 (Tracheostomy Care Supplies - Policy Article); A56717 (Billing and Coding: Respiratory Therapy (Respiratory Care)).
What is ICD-10-CM code J95.00?
J95.00 is the ICD-10-CM code for unspecified tracheostomy complication, in category J95 (Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified), chapter 10: Diseases of the respiratory system.
Next steps
- Run a reimbursement report for a device billed under A7047
- Watch A7047 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A7047
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 10: Diseases of the respiratory system · All diagnoses · HCPCS lookup