Summary & Overview
HCPCS A4628: Oral and Oropharyngeal Suction Catheter
HCPCS Level II code A4628 represents an oral and/or oropharyngeal suction catheter, a single-use medical supply used to clear secretions from the mouth and oropharynx. These devices support airway patency in a range of acute and procedural settings and are commonly billed across hospitals, emergency departments, and outpatient surgical locations. Nationally, correct coding for disposable suction catheters matters for supply-chain accounting, clinical documentation, and claims processing given frequent use and high-volume utilization.
This analysis includes payer perspectives for Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find information on common billing and coverage considerations, payer-specific reimbursement practices where available, and typical clinical contexts for use. The content summarizes benchmarks for utilization and billing patterns, notes policy updates that affect coverage and documentation expectations, and situates the code within clinical workflows for airway management.
The publication is intended for billing professionals, revenue cycle leaders, and clinicians who manage procedural supplies. It highlights practical billing context, national policy trends, and documentation elements tied to HCPCS Level II code A4628. Data not available in the input.
Billing Code Overview
HCPCS Level II code A4628 describes an oral and/or oropharyngeal suction catheter, each. This item is a single-use suction catheter intended for clearing secretions from the oral cavity and oropharynx.
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Service type: Medical supply for airway clearance and secretion management
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Typical site of service: Hospital inpatient and outpatient settings, emergency departments, urgent care, and other acute care locations where airway suctioning is performed
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric inpatient in an acute care hospital, emergency department, or skilled nursing facility with oral or oropharyngeal secretions causing airway obstruction or aspiration risk. Common presentations include respiratory distress from excessive secretions, ineffective cough due to neurologic impairment (stroke, traumatic brain injury), postoperative accumulation of secretions after anesthesia, or inability to clear oral secretions in patients with tracheostomy or mechanical ventilation.
Workflow: A nurse or respiratory therapist evaluates the airway and determines need for suctioning. Standard oral/oropharyngeal suctioning is performed using a single-use suction catheter coded as A4628 passed into the mouth or oropharynx while monitoring oxygenation and clinical status. Documentation includes indication, device description, patient tolerance, number and size of catheters used, suction settings, and response. If performed as part of a procedure (e.g., during bronchoscopy or airway intubation), interdisciplinary documentation records roles, time, and any concurrent services.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Procedure performed without modifier | Rarely appended; default when no modifier applies |