Need CPT Codes for my recent mask purchase

Guest · Post by **Guest** » Fri Nov 02, 2007 9:41 am

Hi Gang!

I keep searching, but am not finding the exact CPT-4 codes I need for my reimbursement claim.

I bought my Nasal-Aire II this time from Direct Home Medical, instead of our lovely host, because they offer the full all 6 prongs in one kit mask, and our host does not.

The upside? Got the kit in lightening fast time. Downside? No codes on my invoice. Unlike our lovely host.

So, can someone help me find that Medicare link that has CPAP mask codes on it?

Many thanks!!!
Barbara/Babette

Slinky · Post by **Slinky** » Fri Nov 02, 2007 9:46 am

Are your SURE it is the CPT code you want? Or more likely is it the HCPCS code you want? AMA determines the CPT codes and they aren't willing to let them be posted on the net for free anymore. Its too much of a money maker for them.

Guest · Post by **Guest** » Fri Nov 02, 2007 9:53 am

OOOO.... Looky what I found!!!!!

What are the Insurance Billing Codes or CPT codes for CPAP?
Codes have changed as of January 2003. These updated codes are used to bill insurance and government plans for CPAP items.

§ 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 is CPAP Passover Humidifier
§ E0562 is CPAP Heated Humidifier
§ E0470 RR is BiPAP rental.
§ KO532 NU is BiPAP purchase.

Other CPAP items are listed under A9900, which is miscellaneous.

Did a Google search for "CPT codes for CPAP" and found this on sleepnet!

Cheers,
Barbara

Guest · Post by **Guest** » Fri Nov 02, 2007 9:55 am

How embarrassing.... I now see those codes are ON MY INVOICE FROM DIRECT HOME MEDICAL!!!!

Okay, I'm stupid. Going to crawl back under my rock now.
Babette the Dim

msheda · Post by **msheda** » Fri Nov 02, 2007 9:57 am

Be sure your bill like a DME

1 § A7034 is CPAP nasal mask, including all nasal masks, Nasal Aire, Breeze, Spiritus.
6 § A7032 is CPAP nasal mask cushion.
1 § A7035 is CPAP headgear.

Slinky · Post by **Slinky** » Fri Nov 02, 2007 11:10 am

Hokay, here is more than what you asked for and possibly more than you wanted to know:

From cpap.com FAQs:

What is a CPT code?
CPT is an acronym for Current Procedure Terminology. CPT codes refer to procedures or services performed by physicians on or for patients. Your insurance company may tell you you need a CPT code to finish filing a claim, when what you really need to provide is a DME code.
Back to Insurance.

What is a DME code?
DME is an acronym for Durable Medical Equipment. A DME code refers to the equipment you purchase and it is the code you need to provide your insurance company when filing a claim. If your insurance company asks for a CPT code, this is what they are talking about.
Back to Insurance.

What does HCPCS mean?
HCPCS is an acronym for Health Care Procedure Coding System and refers to the system of coding for services and equipment used by physicians, medical equipment suppliers, and insurance companies.
Back to Insurance.

What are the codes for the equipment I purchased?
Click here to view our list of DME HCPCS codes for CPAP equipment.
Back to Insurance.

Current Procedural Terminology © 2007 American Medical Association. All Rights Reserved
https://www.wellmark.com/e_business/pro ... es/osd.htm

http://reimbursement.respironics.com/do ... lHints.pdf

Medicare allowables and fee schedules.
http://www3.palmettogba.com/dmecs/do/search

CPT codes are for the DIAGNOSTIC procedures used to determine your problem, be it OSA or rumparoo of the blow hole. The actual CPT codes also list the expected reimbursement for the listed procedure which is ANOTHER reason for the AMA to NOT want patients to access the CPT codes for free on the internet, in addition to that organization's deriving a significant portion of their income from the sale of the CPT coding system.

And when you run across mention of the ICD or ICD-9 codes and wonder what THEY are, they are the actual diagnostic codes to identify your diagnosis.
http://icd9cm.chrisendres.com/

So, in order of use:

1] Your doctor will include a tentative ICD-9 code on your script for a procedure such as blood tests or a sleep evaluation.
2] The CPT code will be used for insurance reimbursement purposes to identify the procedure being done, for reimbursement the ICD-9 code will also need to be included.
3] The HCPCS code is the one correctly used to identify the equipment you are provided w/in order for the supplying facility to be correctly reimbursed.

Guest · Post by **Guest** » Fri Nov 02, 2007 4:40 pm

Well...... I got a note from my insurance requesting the "CPT-4" code for an item I had purchased from CPAP.com. I told them it didn't have one - it was for the quick connect, and I was happy to eat the $4 charge.

Hence, my request for a "CPT-4" code, since that's what the Insurance asked ME for.

I believe you, but I think between all the different codes and terms for those codes, the insurance CSR's get confused too.

LOL,
B.

Slinky · Post by **Slinky** » Fri Nov 02, 2007 4:47 pm

Yer right on!! Look again at cpap.com's explanation in the Quote Box. They've learned to live w/the ..... stupidity and work around it.