Local Coverage Determination · DME MAC
L33612
Suction Pumps
Version 26. CMS effective date 01/01/2024. CMS updated 12/07/2023. Read from the CMS Coverage API on 2026-10-13. Contractors on the report: CGS Administrators (DME MAC) and Noridian Healthcare Solutions (DME MAC).
CMS coverage policy citation. CMS Manual System, Pub. 100.03, Medicare National Coverage Determinations Manual, Chapter 1, Section 280-1
Coverage indication
In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement: The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section. The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section. Refer to the related Local Coverage Policy Article for Suction Pumps for additional information about the statutory requirements for payment and information about correct coding. Refer to the Supplier Manual for additional information on documentation requirements. Refer to the DME MAC web sites for additional bulletin articles and other publications related to this LCD. For the items addressed in this LCD, the “reasonable and necessary” criteria, based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity. A gastric suction pump (E2000) is used to remove gastrointestinal fluids under continuous or intermittent suction via a tube. Use of a gastric suction pump and related supplies are covered for beneficiaries who are unable to empty gastric secretions through normal gastrointestinal functions. Use of a gastric suction pump for other conditions will be denied as not reasonable and necessary. Supplies (tubing, tape, dressings, etc.
Excerpt from the LCD indication. Full text on CMS.
Documentation requirements
Items covered in this LCD have additional policy-specific requirements that must be met prior to Medicare reimbursement. Refer to the LCD-related Policy article, located at the bottom of this policy under the Related Local Coverage Documents section for additional information.
Related articles
- A55426 · Standard Documentation Requirements for All Claims Submitted to DME MACs
- A52519 · Suction Pumps - Policy Article
Related NCDs
- NCD 280.1 · Durable Medical Equipment Reference List (version 4)
HCPCS codes on this LCD
9 other Level II codes are on the LCD and are not given a page in this set: A4624, A4628, A7000, A7001, A7002, A7047, A9272, E2000, K0746.
Questions
What does LCD L33612 cover?
L33612 is Suction Pumps. It is a current final DME MAC local coverage determination, version 26.
Where is the CMS source for L33612?
The Medicare Coverage Database page for LCD L33612 version 26.
Get the signed answer via API
The signed answer is the receipt for this code on a date of service: the rule that was in force, with a hash you can replay. The call needs an API key. The source archive and as-of resolution are public.
curl -H "X-API-Key: $VERZI_API_KEY" \
"https://api.verzi.health/v1/rules/warrant?hcpcs=A4216&as_of=2024-01-15&npi=1234567890&state=UT"