Does Medicare Cover Gastric Suction Pump Canisters?
This article was updated on: 09/10/2018
If you are a Medicare beneficiary and your doctor believes that a gastric suction pump is medically necessary to treat your condition, Medicare will usually cover allowable charges for the device and associated supplies.
What is gastric suction used for?
According to the U.S. National Library of Medicine, gastric suction is used to remove the contents of your stomach. Depending on your health condition, gastric suction, also known as gastric lavage, stomach pumping, or nasogastric tube suction, can be used to accomplish several different things:
- It can be used to remove poisons or excess medications from the stomach.
- If you have been throwing up blood, your doctor may suction your stomach before performing an upper endoscopy test.
- Your doctor can use gastric suction to remove stomach acids for testing.
- It can be used to relieve pressure in your abdomen if you have a blockage in your intestines.
There are also certain health conditions that interfere with your body’s normal gastrointestinal function, making it difficult for you to empty gastric secretions on your own. In those situations, gastric suction pumps may be necessary to remove the gastric secretions for you.
What are the risks with gastric suction pumps?
The U.S. Library of Medicine suggests that the risks of gastric suctioning may include:
- Aspirating, or breathing the contents of your stomach into your lungs.
- Opening a hole, or perforation, in the esophagus.
- Minor bleeding.
Your doctor will explain the reasons for the procedure and any associated risks if he or she recommends gastric suctioning.
What are gastric suction pump canisters?
Gastric suction pump canisters are the reservoirs where the fluids and other secretions in the stomach are stored after the gastric suction pump removes them from your stomach.
Depending on the gastric pump model you choose, you may have either reusable gastric suction pump canisters or disposable, single-use ones.
If you choose a model with reusable gastric suction pump canisters, be sure to follow the manufacturer’s directions for proper cleaning and maintenance to ensure the device works properly and is safe to use.
How does Medicare cover gastric suction pump canisters?
Gastric suction pumps and gastric suction pump canisters you use at home are typically considered durable medical equipment, or DME, under Medicare guidelines. If you have Original Medicare (Part A and Part B), Part B typically pays 80% of the allowable charges for DME after you’ve met your Part B deductible for the year.
Keep in mind, however, that Part B will only pay if both the doctor who orders the gastric suction pump canisters and the supplier who provides them are enrolled in Medicare. Be sure to ask if your DME supplier participates in Medicare, as well, because supplier who participates in Medicare must accept assignment and can only charge you the Medicare-approved amount. If your supplier doesn’t participate, you can be charged a much higher rate.
Depending on where you live, DME may be subject to the Competitive Bidding Program if you are enrolled in Original Medicare. If this applies to you, you must get your gastric suction pump canisters from a supplier contracted with Medicare under the program.
If you are enrolled in a Medicare Advantage plan, coverage for gastric suction pump canisters may be slightly different. Medicare Advantage (Medicare Part C) is an alternative way to get your Medicare benefits. By law, it must cover everything that Original Medicare covers (except for hospice care, which is still covered under Part A), but some plans offer additional cost-saving benefits such as fixed copayments for DME, as well as coverage for routine vision, routine dental, and hearing care.
Note that Medicare Advantage plan benefits and premiums may vary depending on where you live; you must also continue to pay your Part B premium plus any additional premium your plan requires if you choose Medicare Advantage.
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