CPAP billing question

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roguedragon71

CPAP billing question

Post by roguedragon71 » Tue Apr 24, 2012 11:20 am

Hello group...I am not brand new to billing Medicare, however I am to the PAP HCPCs. I am hearing mixed responses as to how to bill. I am being told that, for example, when billing the FFM HCPC A7030, that you cannot bill the mask interface (cushion)HCPC A7031 at the same time. The same goes for nasal mask/cushion and pillows style. From what I have heard prior to this, as it is two different billing codes, that Medicare can be billed for both at the same time, and that seperate dates of service are not required. I have asked others in my office, and have received mixed responses. Any help provided is greatly appreciated.

Thanks in advance....
RD71

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chunkyfrog
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Re: CPAP billing question

Post by chunkyfrog » Tue Apr 24, 2012 11:58 am

As an initial mask purchase, the mask comes WITH a cushion/pillow (interface)
Any attempt to bill the mask as separate parts will probably raise the ire of Medicare.
Best not to screw with them--it's not worth it.
As to replacement parts, I would not see anything wrong with a SPARE cushion--(check with local requirements)
Charging for the first one would be double-billing--since it's included with mask purchase.
Medicare hates that! Patients do, too.
EDIT---Note: in 2018, this is the opposite of Medicare policy.
Please disregard this outdated/incorrect information.

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Re: CPAP billing question

Post by Janknitz » Tue Apr 24, 2012 1:41 pm

As an initial mask purchase, the mask comes WITH a cushion/pillow (interface)
Any attempt to bill the mask as separate parts will probably raise the ire of Medicare.
Best not to screw with them--it's not worth it.
DME's do it all the time. Ever look at your EOB??? It's parted out, even if they give you a sealed package containing a complete mask and headgear.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm

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chunkyfrog
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Re: CPAP billing question

Post by chunkyfrog » Tue Apr 24, 2012 1:45 pm

Once.
I considered it fraudulent billing, and went with another supplier.
Edit: the subsequent DME does no such thing--yet.

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Re: CPAP billing question

Post by NateS » Tue Apr 24, 2012 3:08 pm

roguedragon71 wrote:Hello group...I am not brand new to billing Medicare, however I am to the PAP HCPCs. I am hearing mixed responses as to how to bill. I am being told that, for example, when billing the FFM HCPC A7030, that you cannot bill the mask interface (cushion)HCPC A7031 at the same time. The same goes for nasal mask/cushion and pillows style. From what I have heard prior to this, as it is two different billing codes, that Medicare can be billed for both at the same time, and that seperate dates of service are not required. I have asked others in my office, and have received mixed responses. Any help provided is greatly appreciated.

Thanks in advance....
RD71
It's pretty well summarized on the ResMed site:

http://www.resmed.com/us/documents/1013 ... sories.pdf

Regards, Nate

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chunkyfrog
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Re: CPAP billing question

Post by chunkyfrog » Tue Apr 24, 2012 5:26 pm

Interesting.
Then, when I purchased my first Swift FX mask, the billing from Somnos
was for A7034 (the mask),
A7035 (the headgear),
and A7037 (the tubing on the front of the mask--the short tube that connects to the pillows)
--They said they had to do this because insurance reimbursement was too low for that mask.
So BCBS got rooked, as I had met my deductible for that year.
BTW, Somnos admitted this in an email I have on my computer at work.

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gbito

Re: CPAP billing question

Post by gbito » Sat Jul 28, 2012 9:32 am

My supplier does the same thing - bills for the entire setup, then follows with billing for each individual component. In effect, double-billing insurance. When I spoke with my insurance company to expose this, the agent, (Alba G. from CIGNA), said that is the way they tell the suppliers to bill and didn't seem concerned at all that they were paying them double. It's no wonder health care costs are through the roof!

CPAP Respresentative

Re: CPAP billing question

Post by CPAP Respresentative » Wed Feb 12, 2014 9:14 pm

To everyone one here inquiring, let me clear a couple things up. I work in the CPAP/BiPAP unit at a local DME company. The original question here was whether you can bill the Nasal Interface and the Mask at the same time. The answer to that question is no, Medicare guidelines state that the Nasal Interface is included with the Mask for billing. As for the gentlemen/lady who saw the A7034, A7035, A7037, 7038 on their delivery ticket. Those are the supplies that the DME company are allowed to bill for separately at the time of resupply. If it were to be A7034, A7035, A7037, A7038 and A7031 then the A7031 would not be able to be billed due to the fact that the Nasal Interface cannot be billed at the same time as the Mask. I hope this clears some things up. I would also be glad to answer any other questions anyone else may have!

jannette.rodriguez@unthsc.edu

Re: CPAP billing question

Post by jannette.rodriguez@unthsc.edu » Thu Feb 02, 2017 8:15 am

Hello, can you please tell me if I can bill A7030 and A7035 together? TY

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Re: CPAP billing question

Post by LSAT » Thu Feb 02, 2017 8:44 am

jannette.rodriguez@unthsc.edu wrote:Hello, can you please tell me if I can bill A7030 and A7035 together? TY
You are responding to a 3 year old post...but..to answer your question. 7030A is a FF mask and 7035A is the headgear. Most insurance allows them to be billed separately even though the mask and headgear are in the same package.

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Re: CPAP billing question

Post by doc4bax » Mon Apr 30, 2018 12:59 pm

I know this is an old thread but there just is not alot of info out there on this.

I have the same issue where my DME provider loves to bill a full face mask (A7030) and also (A7031) together. The thing is, I have a high deductible plan so I am the one getting screwed having to pay for both codes. A7030 includes A7031 in the package.

The problem is the A7030 description is "full face mask" and that is all it says. There is no breakdown that I can find that specifically says "A7030 - full face mask (Headgear, frame and face cushion)" I think this is how they get around it. When I call and question them on this they just say "that's how we bill it" . Well I don't care "That's how we bill it" does not fly with me.

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Re: CPAP billing question

Post by Chris8243 » Mon Apr 30, 2018 5:33 pm

I see it's an old thread but totally relevant for me today.

I got a full head gear replacement supplies today. Came in one sealed bag. The receipt in the bag from the DME has each piece listed separately at very high prices. I googled the set (in the sealed bag) was average $169.

They have listed Headgear $80.00, Frame $195, Cushion $110

This is for Amara View.

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Re: CPAP billing question

Post by LSAT » Mon Apr 30, 2018 6:56 pm

It doesn't matter what the DME puts on the bill to the insurance company. The price is pre negotiated. If the Bill is for $300 the negotiated price may be $150 and normally you pay 20% of that and the Ins Co pays 80%. Your cost may be as little as $30. (Of course this is just an example) Did you read all the previous posts?

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Re: CPAP billing question

Post by palerider » Mon Apr 30, 2018 7:07 pm

Check out amazon, ebay, and other online suppliers to see if you'd save money.

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Re: CPAP billing question

Post by Chris8243 » Mon Apr 30, 2018 9:05 pm

LSAT wrote:
Mon Apr 30, 2018 6:56 pm
It doesn't matter what the DME puts on the bill to the insurance company. The price is pre negotiated. If the Bill is for $300 the negotiated price may be $150 and normally you pay 20% of that and the Ins Co pays 80%. Your cost may be as little as $30. (Of course this is just an example) Did you read all the previous posts?
I did read the previous posts. I'll have to wait to see how the billing turns out. And I do know I will only have to pay what the insurance company deems "reasonable & customary".

I guess my whole problem is the non-transparency of the whole thing. And the cost. Just having a bad day.