Insurance Payments and Codes

Does the insurance company pay the same amount for any mask in a category. Such as, does insurance pay the same for the Air Fit N10/P10 and the Zest Q Nasal or do they have different codes? I know the Airt Fit P10 and N10 have the same code for billing BCBS.

You can get the billing codes from your Insurance company. They may not tell you what the allowable amount is though.

Back in June last year, I asked for their codes as I was getting ready to get a new machine. I also asked about how often they were replaceable under insurance. I now have a new insurance plan..

The HCPC codes were (for me FFM, BiLevel machine, with heated hose)

E0470 – 3 calendar years - Respiratory assist device, bi-level pressure (BiPAP) capability, WITHOUT backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)

A7030 – as needed - Full Face Mask used with Positive Airway Pressure (CPAP/BiPAP/APAP) Device
A7037 – as needed - Tubing used with positive airway pressure device
A4604 – as needed - Heated Tubing used with positive airway pressure device
A7038 – as needed - Filter, disposable, used with positive airway pressure device
A7039 – as needed - Filter, non-disposable (reusable), used with positive airway presssure device
A7046 – as needed - Water chamber for humidifier, used with positive airway pressure device

The rate which can be billed is negociated and any part that falls in that code is the same allowable. It is not unusual for a DME to "part" the mask to make more money, but the allowable for each part is the same.

I have the same info for BCBS but I can't put my fingers on it now.

The codes are dependent on the type of mask, not the brand and model.
Prices allowed by your insurance may be uniform as per type (like Medicare), or may vary, with some insurance.
Many insurance plans follow the example of Medicare, but not all.

The billing codes for a full face mask vs a nasal mask are different. The A7034 code applies to both nasal cushion and nasal pillow masks.
The A7033 for nasal pillows is just for replacement pillows only.
The headgear is always separated even if it is included in the package.

A7034 is CPAP Nasal mask
A7032 is CPAP Nasal mask cushion
A7033 is CPAP Nasal pillows
A7030 is CPAP Full Face mask
A7031 is CPAP Full Face mask cushion
A7044 is CPAP Oral Interface
A7027 is CPAP Hybrid mask
A7028 is CPAP Hybrid mask cushion
A7029 is CPAP Hybrid mask nasal pillow
A7035 is CPAP headgear