Medicare Replacement Schedule

I have been able to find what is claimed to be the Medicare Replacement Schedule for CPAP Supplies that is put out by ResMed, my BC/BS Supplemental, & others.

I don't doubt the accuracy of the lists put out by others, because I have received different supplies based on the frequency they specify.

However, I can't seem to find the actual Medicare Replacement Schedule put out by Medicare.

I have searched on the Medicare website, the My Medicare website, & a Google search.
All of the results bring me only to very general description of what is covered. No frequency is noted.

Does anyone have a link to that Medicare Replacement Schedule?

May be a nebulous area.

http://www.hmenews.com/article/cms-does ... pply-items

http://www.healthcare.philips.com/pwc_h ... _Hints.pdf

http://www.respironics.vgm.com/files/Me ... t-2012.pdf

StuUnderPressure wrote:However, I can't seem to find the actual Medicare Replacement Schedule put out by Medicare.

I have searched on the Medicare website, the My Medicare website, & a Google search.
All of the results bring me only to very general description of what is covered. No frequency is noted.

Does anyone have a link to that Medicare Replacement Schedule?

I can't remember where I found the list, but it is not on the Medicare.gov site. Almost everything about Medicare is contracted out. Also, the replacement schedules can vary in different regions of the country. I think you have to search the http://www.cms.gov site. That's the site for the Centers for Medicare and Medicaid Services. The schedules are on the website of the CMS contractor for your region. I think DHS publishes the official regulations and the CMS contractors then translate them into usable English for medical providers to follow. You actually don't find much of the nitty-gritty daily detail stuff about Medicare on the Medicare.gov web site.

Sorry I can't give a link, but maybe this will help you in your search. Google might be your best friend in this case. Or try a search starting from http://www.usa.gov.

https://www.noridianmedicare.com/dme/co ... _apnea.htm

Problem is it lists codes for supplies, not the supply, next problem is the new rulings say your provider has to ask "how many you have left" of said items and "why you need more". Medicare doesn't want you to stock pile the supplies or to have the ability to sell your spares.

idamtnboy wrote:
Also, the replacement schedules can vary in different regions of the country.

The prices for the various supplies can vary in the different regions, but why would the replacement "frequency" vary?

Because it can.

I got the following response from Medicare.

Note that it does NOT state that the frequency would vary by region.
And, I did NOT give them my specific information, so they are NOT giving me a schedule for ONlY my region.

This response is in reply to your e-mail regarding a link to a very specific replacement schedule for the various CPAP supplies.

I apologize there is not a link that has the list you are requesting. I have listed out the replacement schedule that we have on file for CPAP supplies. I hope that this will give you the information that you need.

1. Tubing with integrated heating element for use with positive positive airway pressure device 1 every 3 months.

2. Full face mask used with positive airway pressure device, each 1 every 3 months.

3. Face mask interface, replacement for full face mask, each 1 every 1 month.

4. Cushion for use on nasal mask interface, replacement only, each 2 every 1 month.

5. Pillow for use on nasal cannula type interface, replacement only, pair 2 every 1 month.

6. Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap 1 every 3 months.

7. Headgear used with positive airway pressure device 1 every 6 months.

8. Chinstrap used with positive airway pressure device 1 every 6 months.

9. Tubing used with positive airway pressure device 1 every 3 months.

10. Filter, disposable, used with positive airway pressure device 2 every 1 month.

11. Filter, non disposable, used with positive airway pressure device. 1 every 6 months.

12. Water chamber for humidifier, used with positive airway pressure device, replacement, each 1 every 6 months.

So, in other words, the desk jockey at Medicare just verified the exact same schedule that is published by ResMed and Respironics. Cool!

http://www.respironics.vgm.com/files/Me ... t-2012.pdf
http://www.resmed.com/us/documents/1013 ... sories.pdf

The problem is the interpretation of what the schedule means, as explained in links in my earlier post. It is not automatic and not necessarily approved just because the schedule might appear to allow it in some circumstances. Thus the lack of clarity in interpretation of said schedule.

And this was Medicare's reply to my followup as to why the Medicare Replacement Schedule could not be accessed by me ON the Medicare website.

This response is in reply to your e-mail regarding is a CPAP replacement schedule available for the public.

The replacement schedule for CPAP accessories is provided to suppliers of Durable Medical Equipment. You may wish to contact your supplier for a copy of the list.

The list that was sent to you in the previous email is the only information that is available to give to you. I apologize for the inconvenience.

Hi there,
I am a new member and this is my first post. My husband and I are both CPAP users with Medicare as primary. We were trying to obtain a list of supplies provided, and at what intervals, because of unscrupulous suppliers. We've never encountered any subjective evaluation based upon defect or level of supplies on hand/remaining. The problem we find here in southeastern Wisconsin is that there seem to be no standards for suppliers, and each company acts or interprets the rules differently. That means service from one supplier to the next can vary by extremes. We've never had a problem getting supplies, but in getting adequate supplies for a given interval; say 3 or 6 months. We contacted Medicare with our concerns & were given the same information, or schedule, as is listed above (in red). Our experience with resupplying is consistent with the list above. This information is not on the web site according to the Medicare gentleman we spoke to.
I thank those of you who provided the PDF documents above. Those are very helpful tools to have available.

kisstheskykneel wrote:Hi there,
I am a new member and this is my first post. My husband and I are both CPAP users with Medicare as primary. We were trying to obtain a list of supplies provided, and at what intervals, because of unscrupulous suppliers. We've never encountered any subjective evaluation based upon defect or level of supplies on hand/remaining. The problem we find here in southeastern Wisconsin is that there seem to be no standards for suppliers, and each company acts or interprets the rules differently. That means service from one supplier to the next can vary by extremes. We've never had a problem getting supplies, but in getting adequate supplies for a given interval; say 3 or 6 months. We contacted Medicare with our concerns & were given the same information, or schedule, as is listed above (in red). Our experience with resupplying is consistent with the list above. This information is not on the web site according to the Medicare gentleman we spoke to.
I thank those of you who provided the PDF documents above. Those are very helpful tools to have available.

You can show the list directly from Medicare to your DME if they do not follow it to the letter.

I have found that lists put out by others (ResMed, etc) do differ (albeit minutely) to the list directly from Medicare.

Set up your "My Medicare" account online.
On there, you can view claims sent in by the DMEs.
If you have any complaint about any specific DME, you can click on that claim & complain about the DME.

It appears Medicare itself authorizes fraud.

Allowing replacement of a lot of those items every 3 months is ridiculous.

I've been using the same heated hose on my S9 for 3 years ( or ever since I got it -- about 3 years ).
I use the Resmed Quattro FX mask and those plastic frames last forever.

Cushions do need to be replaced frequently but even those last a long time if properly cared for.
I rotate 3 cushions and they last well over a year.

Headgear replacement? That NEVER wears out.

I can get 2 Nasal mask cushions per month - but I find that I can get a full month out of 1 cushion before it starts leaking.
So, I am saving Medicare & my BC/BS secondary 50% of the cost.

However, "I" can NOT get 6 months out of a headgear NOR out of a chinstrap.
3 Months would be max for me for those 2 items.

Wonder if I could get Medicare & BC/BS to credit that savings on the Nasal Mask cushions towards the cost of headgear & chinstrap needing replacement more often than they allow.

No, that would be logical.
They don't "do" logical.

Arizona-Willie wrote:It appears Medicare itself authorizes fraud.

Allowing replacement of a lot of those items every 3 months is ridiculous.

I've been using the same heated hose on my S9 for 3 years ( or ever since I got it -- about 3 years ).
I use the Resmed Quattro FX mask and those plastic frames last forever.

Cushions do need to be replaced frequently but even those last a long time if properly cared for.
I rotate 3 cushions and they last well over a year.

Headgear replacement? That NEVER wears out.

Somewhere, in another post I think I remember reading that starting 2013 those supplies covered under Medicare would be 'allowed' under that replacement schedule, WHEN REQUESTED. In other words, DME's cannot just send them. For me this is good, since my DME likes to just send tooooo much stuff. If I remember correctly, I will need to call & ASK the DME for a replacement. For me that means I won't request regular hoses probably ever again, since Nationwide sent so many in previous years. I also won't request stuff I don't need. They cannot just send me stuff anymore, so in my way of thinking, I can do my little part to cut Medicare costs by only requesting supplies as needed & saving money by not requesting stuff I don't need.

Food for thought.
Jen