Question about Mask Replacement

[retrodave15]

I was on the phone with United Heathcare this morning and they were no help. I have been on CPAP for about 2 months and I was trying to figure out what the replacement schedule for the consumables was. She could not tell me unless I had the codes for each item. Any one know where I can find the CPT / HCPCS codes for the following items:

Mask seal for Mirrage Quattro
headgear
6' Hose
Foam Filter
Pollen Filter

She told me that the replacement for consumables was every 6 months, which seemed a long time for the silicone mask seal, I have had mine for 2 months now and silicone part is starting to get a bit yucky.

[LSAT]

I was on the phone with United Heathcare this morning and they were no help. I have been on CPAP for about 2 months and I was trying to figure out what the replacement schedule for the consumables was. She could not tell me unless I had the codes for each item. Any one know where I can find the CPT / HCPCS codes for the following items:

Mask seal for Mirrage Quattro
headgear
6' Hose
Foam Filter
Pollen Filter

She told me that the replacement for consumables was every 6 months, which seemed a long time for the silicone mask seal, I have had mine for 2 months now and silicone part is starting to get a bit yucky.

I have a Quattro and I change the silicone filter every 3-4 months. I do not clean it daily, but I use wipes.
I use a hose for about a year ...rinsing it weekly with hot water only.
I change my machine filter according to the manufacterers guidelines...every 3 months
The mask is plastic and will last a loooong time with changing the silicone...I change the mask yearly...I have never changed the headgear alone.

The medicare schedule allows a silicone replacement monthly...a mask every 3 months...filters monthly.
Private insurance will vary by company. I think these replacement schedules are far too liberal...maybe that is part of our problem with high medical and insurance costs.

Billing Codes.... http://www.cpap-accessories.com/cart/in ... x&cPath=21

[retrodave15]

I wash my mask weekly, and wipe it down daily with mask wipes. However I have super oily skin and the silicone is part is starting to yellow a bit. My leak rate is going up as well.

The rest of the parts will last a long time with proper care. My Canadian buddy who just moved down here has had the same mask and seal for 3 years due to the "rules" of "Canada care" I gave him one of my masks that i could not use instead of "throwing it away"

[anglett]

As far as I know there's not a specific code for brand or size for billing. Its been a long time since I've worked in coding but these are current.
A7031 is the mask cushion and A7035 is for the headgear.
A7037 is for the hose and A4604 if it's heated hose.
A7038 is the filter. It's coded as disposable. I'm not sure about a pollen filter I would think it would be the same code. There's one for a non-disposable (A7014) but I'm not too educated in all the different machine types to know what's what. I'm new to cpap so I well educated in the healthcare field but dumb as dirt in all things CPAP.

[sleepnationtv]

For Most private insurances this is the schedule

Mask 6 mo
Cushion 3mo
Headgear 6mo
Tubing 6mo
water cannister 6mo
2 filter per 3-6 mo
machine 5 years

Hope this helps

Dane

[retrodave15]

I got this today from my DME. Wow they shared information with me. Actually I love my DME and my RT Cindy. She even knows about sleepyhead and asked me to check my leak line when we were experimenting with masks.

Some good info to share.



I could not figure out how to make a table so I posted an image

[NotSleepingBeauty]

That is great information! I wonder if I could get the same from my DME for BC/BS... I'm gonna ask!

[Kairosgrammy]

I think it has to do with what your sleep doc prescribed. Mine prescribed every 3 months for mask and 6 mo. for hoses. Btw, what is the difference between the foam filter and the pollen filter. I could use that with my bad allergies and sinuses.

I was on the phone with United Heathcare this morning and they were no help. I have been on CPAP for about 2 months and I was trying to figure out what the replacement schedule for the consumables was. She could not tell me unless I had the codes for each item. Any one know where I can find the CPT / HCPCS codes for the following items:

Mask seal for Mirrage Quattro
headgear
6' Hose
Foam Filter
Pollen Filter

She told me that the replacement for consumables was every 6 months, which seemed a long time for the silicone mask seal, I have had mine for 2 months now and silicone part is starting to get a bit yucky.

[StevenXXXX]

She told me that the replacement for consumables was every 6 months, which seemed a long time for the silicone mask seal, I have had mine for 2 months now and silicone part is starting to get a bit yucky.

My BCBS plan follows the Medicare replacement schedule.

In late October 2011 before I purchased my new ResMed S9 AutoSet in late December 2011, I got some supplies for my old 8 year old Respironics.

As it has always been, I was able to buy two (2) cushions for the Respironics ComfortGel Mask.
The replacement schedule allows for two (2) cushions per month.

You of course don't need to replace them that often, but when I bought cushions, I always was able to buy two at a time.

[retrodave15]

@Kairosgrammy

Btw, what is the difference between the foam filter and the pollen filter. I could use that with my bad allergies and sinuses.

The System One machines have a foam filter which is gray and there is an optional white pollen filter. The pollen filter goes in first and the gray one goes in second. My RT at my DME asked me if I had allergies, when I said yes, she gave me 3 pollen filters and 1 grey filter for my machine. She told me to rinse the gray filter weekly and change the pollen filter monthly. I just put my last pollen filter in and I was checking to see if they covered the replacement.

The pollen filter is the disposable filter in my list from United. The non disposable filter is the gray filter.

[Pugsy]

Btw, what is the difference between the foam filter and the pollen filter. I could use that with my bad allergies and sinuses.

Respironics machines have 2 filters available for use.

A gray foam filter which is washable and insurance normally will allow replacement every 6 months but it really is not necessary to replace that often. It can be washed easily, pat dry, air dry rest of it and replaced in the machine.

The other filter is the disposable white fine filter. When it gets dirty it is noticeably very gray. This is the one that Medicare will allow 2 per month. How often it really needs to be changed is going to be from your air quality in your house and your personal preference. For someone with allergies and nasal problems I would do it every couple of weeks or even sooner if you notice a huge difference.
The can be bought it bulk very cheaply on EBay. I got 24 of the fine white disposable filters on Ebay for $11.99 and that included mailing.

White fine filter goes in first...fuzzy side outward to catch stuff...then the gray foam filter faces the outside and is the first filter that is used to get stuff out of the air.
White fine filter is considered optional...but for me after seeing how nasty it gets...I don't think it is optional.

[retrodave15]

Question about the Respironics pollen filters, one had a tab and one did not. is there a difference? Can I just cut the tab off?

[imsleepynomore]

The tab on the white filter doesn't need to be there lately my supplier has issued the tabless white filter and I have had no problem with them in fact I think they fit in tighter and are just as effective

[Kairosgrammy]

When I go in for new mask will check on the filters. Anything that will keep my allergies at bay is appreciated particularly when in a month or so, pollen will be hot and heavy where I live.

Btw, what is the difference between the foam filter and the pollen filter. I could use that with my bad allergies and sinuses.

Respironics machines have 2 filters available for use.

A gray foam filter which is washable and insurance normally will allow replacement every 6 months but it really is not necessary to replace that often. It can be washed easily, pat dry, air dry rest of it and replaced in the machine.

The other filter is the disposable white fine filter. When it gets dirty it is noticeably very gray. This is the one that Medicare will allow 2 per month. How often it really needs to be changed is going to be from your air quality in your house and your personal preference. For someone with allergies and nasal problems I would do it every couple of weeks or even sooner if you notice a huge difference.
The can be bought it bulk very cheaply on EBay. I got 24 of the fine white disposable filters on Ebay for $11.99 and that included mailing.

White fine filter goes in first...fuzzy side outward to catch stuff...then the gray foam filter faces the outside and is the first filter that is used to get stuff out of the air.
White fine filter is considered optional...but for me after seeing how nasty it gets...I don't think it is optional.

[NotSleepingBeauty]

MY DME told me 6 months for everything. I don't think that is correct. I remember the RN that gave me my CPAP told me about the Medicare guidelines.