`A7501` Tracheostoma valve w diaphra

Tracheostoma valve, including diaphragm, each

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 1 units per day (clinical), rationale: Nature of Equipment
DME supplier: max 3 units per day (clinical), rationale: Published Contractor Policy

Medicare pricing for A7501

DMEPOS fee schedule, July 2026 (DME26-C)

no modifier, ostomy, tracheostomy and urological (OS): non-rural $149.66 in the contiguous states; $149.66 to $179.61 in AK, HI, PR and VI; ceiling $149.66, floor $127.21

Physician Fee Schedule (CY 2026, RVU26D)

Status X: statutory exclusion, not paid under the PFS.

Payer policies and prior authorization for A7501

Payer coverage policies that name A7501

A7501 appears in 2 coverage policies from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Suction Pumps (0503)	listed, no stance (range A7501-A7527)	Jul 2, 2026	payer document
Aetna	Tracheostomy Supplies (0074)	covered if criteria are met	Mar 18, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in KY, LA, MA, NY, OH, VA.

AZ: $178.60 (dme), effective Oct 1, 2026
CO: $115.51 (chp_plus, non-facility), effective Jul 1, 2026
IL: $99.91 (dme), effective Jan 1, 2026
IN: $124.72 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KY: $100.18 (dme), effective Jan 1, 2026
LA: $0.91 (dme), effective Jul 1, 2012
MA: $121.80 (dme_rates), effective Mar 1, 2026
MD: $127.21 (dme), effective Apr 1, 2026
MS: $119.73 (comprehensive), effective Jul 1, 2026
ND: $185.15 (dme), effective Aug 1, 2026
NE: $130.96 (dme), effective Jul 1, 2026
NY: $102.78 (dme), effective Jul 1, 2026
OH: $97.80 (dme), effective Jan 1, 2024
OK: $149.66 (dme), effective Jan 1, 2026
VA: $134.69 (dme), effective Dec 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

A7501 Tracheostoma valve w diaphra