getting a new mask, after a year's use

syanne · Post by **syanne** » Fri Apr 04, 2008 8:28 pm

When I started with CPAP last July, I was told that the mask had to be replaced every year. Do I need a prescription from the doctor to get the replacement mask? I am thinking I might need a prescription, to be coved by my insurance.

bap40 · Post by **bap40** » Fri Apr 04, 2008 8:38 pm

I was told by my DME, insurance would pay for a new mask every 6months. Now, I don't know if the masks actually wear out that fast or not. I'm sure someone with more knowledge will respond with on this subject.

6PtStar · Post by **6PtStar** » Fri Apr 04, 2008 9:53 pm

Medicare and most insurance companies follow the attached schedule for replacement. How fast a mask goes bad depends on the mask. Skin oils generally begin make the seals stiff after 6 months and they leak more even though they are still usable.

HCPCS Code Description Allowed Replacement Frequency
A7030NU Full Face Mask 1 every 90 days
A7031NU Full Face Cushion 1 every 30 days
A7034NU Mask 1 every 90 days
A7045 Exhalation Port with or without Whisper Swivel Span Not Yet Released
A7032NU Mask Cushion 2 every 30 days
A7044NU Oracle 1 every 90 days
A7033NU Nasal Pillows 2 pairs every 30 days
A7035NU Headgear 1 every 180 days
A7036NU Chinstrap 1 every 180 days
A7037NU Tubing 1 every 90 days
A7039NU Non-Disposable Filters 1 every 180 days
A7038NU Disposable Filters 2 every 30 days
A7046 Humidifer Chamber 1 every 180 days
E0601NU CPAP Varies Greatly - Call For More Information
E0470NU BiPAP Varies Greatly - Call For More Information
E0562NU Heated Humidifier Varies Greatly - Call For More Information
E0561NU Passover Humidifier Varies Greatly - Call For More Information

The schedule on many masks especially Full Face Masks is one every 3 months but the headgear is replaceable only every 6 months. Most suppliers will not sell the mask without the headgear (even though they bill the headgear seperately), so one mask every 6 months is about all you can get.

The need for a script depends on company policy. I hade one DME tell me the script was good for a year. Another DME told me I had to get a new script for every new mask. Most online sellers like cpap.com do not require a script for a mask, ever and one script for a cpap is good for life.

Jerry