Medicare Replacement Schedule for CPAP Equipment

[Comfortably Numb]

Does anyone have a link to the Medicare document that summarizes the approved replacement intervals for CPAP equipment? There is so much crap on the internet that it's hard to separate the .com DME's from the real deal. thanks

[sc0ttt]

Given to me by the DME... fwiw

[Pugsy]

https://med.noridianmedicare.com/docume ... leep+Apnea

Medicare hides it deep within the bowels of their website
viewtopic/t82025/Medicare-replacement-schedule.html

And a round about schedule from a government watchdog agency....page 4
https://oig.hhs.gov/oei/reports/oei-07-12-00250.pdf

[Helpful Guest :-)]

Does anyone have a link to the Medicare document that summarizes the approved replacement intervals for CPAP equipment? There is so much crap on the internet that it's hard to separate the .com DME's from the real deal. thanks

I can't post links but...
If you add the search term ( .gov) to your search terms that should help narrow it down. So you will be looking for either medicare, hhs, or cms ( .gov).

Avoid using (.com) or DME sites if you want just Medicare rules as that will be their interpretation - right or wrong.

You could copy & paste this (Replacement Schedules for Medicare Continuous Positive Airway .gov)

Also keep in mind many people here have a Medicare "Advantage" plan which is different and you have to check with that plan provider as they act as a "gate keeper" and can often have different requirements tho most everyone today will replace things when "medically necessary" meaning the time requirements can vary esp. if something is broken or damaged early than a scheduled time.

Normally, the DME will have to get "approval" from the "gate keeper" or Advantage Plan provider which adds another step to the process.

I think some also confuse Medicaid and Medicare.

Is there a particular item you are looking for?

[Comfortably Numb]

Many thanks to you all. I can assure you that I looked on the .gov site first. Then I just Googled the question. The info. is not as readily available as most of my Google searches. "Deep within the bowels" is a perfect description!

[THE Helpful Guest :-)]

Is there a particular item you are looking for?

Guess we will never know.

[Comfortably Numb]

Is there a particular item you are looking for?

Guess we will never know.

Yes:

Does anyone have a link to the Medicare document that summarizes the approved replacement intervals for CPAP equipment?

Got it now. thanks!

[Comfortably Numb]

Wow, did I ever open a can of worms:
viewtopic/t85890/Medicare-Replacement-Schedule.html

I can see that this trail of s_it has been traveled many times before. My DME told me today that I can get the information from medicare.gov According to this thread, Medicare can't release these secrets to lowly individuals like me--the details must be obtained from your local DME. Such absolute BS!

[LSAT]

Given to me by the DME... fwiw

This is not current, There have been changes

[SewTired]

Here's the listing I got from Lincare. It matched something Pugsy linked to some time ago. It probably doesn't include everything as I just saved what I needed. This is the original Medicare replacement list. If you have other insurance, the frequency may be different. In addition, some DMEs will not separate mask from headgear thus you will ONLY Get a complete mask and headgear every 6 months. It's how their billing office interprets it. For the same reason, some DME's give you a fit pack and others will only give you a fit pack the first time and after that, it only contains the size pillow/cushion that you needed.

Item Replacement Frequency
CPAP Mask Every 3 months
CPAP Headgear Every 6 months
CPAP Tubing Every 6 months
Disposable Filter 2 new filters every month
Non-disposable Filters 1 new filter every 6 months
CPAP Chin strap Every 6 months
Nasal Pillows Two per Month
Cushions One per Month
Humidifier Chamber Every 6 months

[LSAT]

https://www.sleepapnea.org/treat/cpap-t ... equipment/

[Comfortably Numb]

https://www.sleepapnea.org/treat/cpap-t ... equipment/

Thanks. That agrees with the other listings I've seen. Good one to bookmark.

[SewTired]

my insurance refuses to pay unless i get it from one of their approved DMEs

no matter that i can get it cheaper and with less crapola thrown in like the last DME did

DMEs apparently have gotten too much power to screw us over so they can make more profit

No, it's because when insurance companies negotiate, there is an expected number of purchases that are part of the negotiation. You cost the company a lot of money to deal with on an individual basis vs. thousands of transactions that are simply done via computer. So, you don't actually save them a dime by buying your own and then demanding reimbursement. Most insurance companies today pay a negotiated rate, not the retail price.

On the other hand, if they repeatedly have to deal with wrong billings and complaints from their membership, then they are going to start looking at some OTHER DME to provide services. Why? Because it's either that or they are going to have to hire more customer service reps to resolve the problems caused by the DME. Heads cost money.

What I hate about Medicare's bidding program was that they went with the lowest price with no concern whatsoever about patient care since Apria had one of the worst reputations in the business (and still does).

[RobertS975]

A recent thread with some Pugsy answers: viewtopic/t155872/viewtopic.php?f=1&t=1 ... 8#p1177488