A4625 — Tracheostomy care kit for new tracheostomy
A4625 is a HCPCS Level II code for tracheostomy care kit for new tracheostomy. It belongs to the Transportation, Medical & Surgical Supplies, Administrative section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of A4625 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 30 units MAI 3 — Date of Service Edit: Clinical · Published Contractor Policy
- outpatient
- 30 units MAI 3 — Date of Service Edit: Clinical · Published Contractor Policy
- DME supplier
- 100 units MAI 3 — Date of Service Edit: Clinical · Published Contractor Policy
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for A4625
- Long descriptor
- Tracheostomy care kit for new tracheostomy
- Short descriptor
- Trach care kit for new trach
- Added
- January 1, 1990
- BETOS
- D1F
- Pricing indicator
- 37 — DMEPOS
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Ostomy, tracheostomy and urological supplies. Price subject to floors and ceilings.
Codes adjacent to A4625
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A4625 is not quite right, the correct code is very often within a few positions of it.
- A4615Cannula, nasal
- A4616Tubing (oxygen), per foot
- A4617Mouth piece
- A4618Breathing circuits
- A4619Face tent
- A4620Variable concentration mask
- A4623Tracheostomy, inner cannula
- A4624Tracheal suction catheter, any type other than closed system, each
- A4626Tracheostomy cleaning brush, each
- A4627Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler
- A4628Oral and/or oropharyngeal suction catheter, each
- A4629Tracheostomy care kit for established tracheostomy
- A4630Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient
- A4633Replacement bulb/lamp for ultraviolet light therapy system, each
- A4634Replacement bulb for therapeutic light box, tabletop model
- A4635Underarm pad, crutch, replacement, each
Questions about A4625
What is HCPCS code A4625?
A4625 is a HCPCS Level II code for tracheostomy care kit for new tracheostomy. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A4625?
The CMS HCPCS file marks A4625 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is A4625 paid under the physician fee schedule?
A4625 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.