new prescr. required to get an APAP?

ScottGA · Post by **ScottGA** » Sun Jan 29, 2006 8:34 am

Thanks everyone for all the great info on best machines. Do you think I need to go to the Dr. to get a new prescr. to order an APAP. I think my prescr. called for 'CPAP'. Or do all machines come under the prescr. heading 'CPAP'? I would just as soon not have to bother with the Dr. again.
Also, with limited free time for analysis, I may forego the software option.

Jeeper · Post by **Jeeper** » Sun Jan 29, 2006 9:27 am

You will need a prescription to purchase a CPAP, BiPap or APAP. If you order online, the supplier only cares the prescript shows CPAP. You can buy any type of machine with it.

If you plan to order and pay out of pocket, simply ask your doctor for a cpap prescription for your files. If you still have a copy of the old one it will work.

If you are using insurance to pay for it that may be a different story. It may even involve another sleep study. My insurance requires another study when buying a machine.

Wulfman · Post by **Wulfman** » Sun Jan 29, 2006 9:31 am

Scott,

The following is the list of CPT codes for CPAP reimbursement.
As you can, see there is only one code for CPAP purchase (which also covers APAPs).
So, to answer your question....."No", you don't need another prescription if you still have your original one.
If you're on a fixed pressure CPAP, and if you order an APAP, it will come cofigured as a CPAP on that fixed pressure.

Best wishes,

Den

CPT codes for CPAP and Bilevels:

* EO601 RR is CPAP rental.
* E0601 NU is CPAP purchase.
* A7034 is CPAP nasal mask, including all nasal masks, Nasal Aire, Breeze, Spiritus.
* A7032 is CPAP nasal mask cushion.
* A7030 is CPAP Full Face mask.
* A7031 is CPAP Full Face mask cushion.
* A7044 is CPAP Full Oral Interface.
* A7046 is CPAP Humidifier Chamber.
* A7037 is CPAP tubing, long and short hoses.
* A7038 is CPAP disposable filter.
* A7039 is CPAP gross particle (foam) filter.
* A7035 is CPAP headgear.
* A7033 is CPAP nasal pillows.
* A7036 is CPAP chinstrap.
* E0561 NU is CPAP Passover Humidifier
* E0562 NU is CPAP Heated Humidifier
* E0470 RR is BiPAP rental.
* E0470 NU is BiPAP purchase.
* E0471 RR is BiPAP-ST rental.
* E0471 NU is BiPAP-ST purchase.
Other CPAP items are listed under E1399, which is miscellaneous.

ScottGA · Post by **ScottGA** » Sun Jan 29, 2006 9:32 am

Yea I'm fed up with the ins. company routine. I hate to byoass them and pay out of pocket, but I think I would end up paying as much with their 'rent plan' at inflated absurd prices. I think they get them cheaper and that is just a way to get us to pay 20% of a high price which = 100% of the REAL price. Any why get a newsleep study only 7 months after the first one, what a waste of insurance(MY) money! Thanks again for the info.

ScottGA · Post by **ScottGA** » Sun Jan 29, 2006 9:37 am

Does that mean ordering an APAP is a wast ofmoenyif it comes configured as a CPAP on a set pressure of 8? I don' mind spending money but don't want to throw any away.

Wulfman · Post by **Wulfman** » Sun Jan 29, 2006 10:14 am

ScottGA wrote:Does that mean ordering an APAP is a wast ofmoenyif it comes configured as a CPAP on a set pressure of 8? I don' mind spending money but don't want to throw any away.

Absolutely NOT. If you order the machine from CPAP.COM (for example), you will get the "Home Care Provider Setup Instructions" manual. You will then be able to reconfigure your machine to YOUR preferences (Pressure (range), C-Flex, Ramp, etc.).

Den

Guest · Post by **Guest** » Sun Jan 29, 2006 10:44 am

ScottGA wrote:Do you think I need to go to the Dr. to get a new prescr. to order an APAP. I think my prescr. called for 'CPAP'.

No. You do not need to get a new prescription.

You can alter the pressure setting on any machine, whether it be a straight CPAP machine or an auto. But you would need the software to know whether or not the pressure should be altered based on the nightly results.

yardbird · Post by **yardbird** » Sun Jan 29, 2006 8:19 pm

I'm gonna jump in here because I bought my APAP from cpap.com. My prescription had to say APAP or Auto CPAP.

If it just says CPAP then I don't think you can use that script to buy an APAP. Maybe JohnnyGoodman can jump in here and clear this up.

WNJ · Post by **WNJ** » Sun Jan 29, 2006 9:32 pm

Maybe something has changed, Yardbird, since you bought yours.

I bought a REMstar Auto with humidifier, etc., from cpap.com about three weeks ago. All my prescription said was “CPAP 13cm, use qHS as directed.”

I ordered on-line and faxed my prescription on Sunday. My new REMstar Auto CPAP arrived on Thursday. Great service!

Scott -- Mine came set at 13cm for CPAP, and a range of 4 to 20cm for auto. There was a note inside confirming the settings. With the manual which was included, it only took a few minutes to set a narrower range for use in auto mode.

Wayne

Linda3032 · Post by **Linda3032** » Sun Jan 29, 2006 10:15 pm

Yardbird. Did you pay out of pocket and then get reimbursement from an insurance company? If so, maybe your insurance company required the prescription to say APAP, so CPAP.com required it also.

Scott, I would think your prescription would still be valid to purchase another machine, anytime under one year.

And if you go with a Respironics Auto, you can purchase the software cheaply.

Guest · Post by **Guest** » Mon Jan 30, 2006 12:05 am

From the cpap.com website:

CPAP prescriptions are accepted for Auto Adjusting (APAP) Machines.

yardbird · Post by **yardbird** » Mon Jan 30, 2006 9:07 am

ok... I may have misunderstood the instructions for the APAP prescription. I just had my doctor write a script for Auto CPAP and it all worked out fine. I did buy from cpap.com out-of-pocket because my insurance company was being stupid about the whole thing. .... surprise surprise....

:/

Saltydog · Post by **Saltydog** » Mon Jan 30, 2006 10:52 am

Yardbird-

I am considering buying my own machine also. My DME provided me with a Remstar that is not even made anymore (as far as I can tell). If I buy my own machine, will the DME still provide the hoses, masks, etc. that is paid by my insurance or if I keep their humidifier and switch out machines will they no longer provide the other stuff?

Thinking of an auto with c-flex as have been having great difficulty exhaling against only a 9 cm pressure. Would also like to keep track of my own data.

Guest · Post by **Guest** » Mon Jan 30, 2006 11:42 am

SaltyDog. I think you should talk with your insurance representative to find out their requirements for reimbursement; See if you can buy out of pocket and get reimbursed. If so, you could buy your own masks, etc. Many times the DME's don't have much of a selection, plus they try to talk you into what they have in stock.

Regarding the machine. You probably have a Remstar Auto (no c-flex), which is what I use. It's still a wonderful machine, and you can get a Smart card reader cheaply and download your own data.

If the Remstar Auto is new, and if you are a brand new hosehead, you might stay with it for awhile to make sure you would be compliant. That is if there is a big hassle with the DME and insurance company about returning the unit.

Just a few things to think about before you spend alot of money out of pocket.

Good Luck,
Linda

Guest · Post by **Guest** » Mon Jan 30, 2006 11:43 am

Sorry. I forgot to sign in.
Linda

new prescr. required to get an APAP?

new prescr. required to get an APAP?

Wulfman question

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