Insurance: How often can you get supplies?
Written by Ter on Sunday, September 30th, 2007 in Sleep Apnea Equipment.
Little more info that I’ve posted a few times for the Medicare folks:
Here are the billing codes (HCPC’s) and an idea of Medicare allowable which varies from state to state. Allowables shown are 2004 Washington State allowables They will vary state to state and year to year.
CPAP- Purchased CPAPs (billing code E0601 paid at @ $111.71/mo for up to 15 months-capped rental) (5 years for replacement)
Heated Humidifier- (K0531 @ $301.22)
Mask Frame- 1 per 3 months (A7030 @ $188.64 for a Full Face and A7034 @ $117.64 for a regular mask)
Replacement Mask Cushion- 2 per month (A7031 @ $69.77 for full face & A7032 @ 40.53 for a regular mask cushion)
Head Gear- 1 per 6 months (A7035 @ $39.75)
Chin Strap- 1 per 6 months (A7036 @ $18.20)
Nasal Pillows- 2 pairs per month (A7033 @ 28.41)
Tubing- 1 per month (A7037 @ $41.02)
Filters- 2 disposible per month (A7038 @ $5.39) and 1 reuseable every 6 months (A7039 @ $15.33)
Medicare guidelines are very confusing to many DME personnel. I myself had to read it several times and study hard on my own to understand all the information.
Most insurances are following Medicare guidelines for CPAP supplies so it’s a good base to start with in determining what supplies you are allowed and how often and the “Allowable” amount your portion of the bill will be based on.



