Medicare - finding replacement schedule for your area

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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rested gal
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Joined: Thu Sep 09, 2004 10:14 pm
Location: Tennessee

Medicare - finding replacement schedule for your area

Post by rested gal » Tue Jan 04, 2011 3:00 pm

There's probably an easier, quicker way to find the Medicare reimbursement schedule for your area, but anyway.. here's the way I slogged through...

Starting at: http://www.cms.gov
Centers for Medicare & Medicaid Services

Under "Regulations & Guidance" I clicked "more" to go to this page:
http://www.cms.gov/home/regsguidance.asp

At bottom of the "Regulations & Guidance" page, under "Browse by Special Topic", I clicked "Medicare Coverage Center" which opened this page:
http://www.cms.gov/center/coverage.asp

On the Medicare Coverage Center page, under "Important Links - Coverage Process" I clicked "Local Coverage Determinations" which opened:
http://www.cms.gov/DeterminationProcess ... #TopOfPage

On the Local Coverage Determinations page, I clicked "LCDs by State"

On the page for LCDs by State Index Criteria I selected Tennessee in the drop down menu, then clicked "submit report."

That took me to Select a contractor to view a list of LCDs
On the far right side of the table, under the column for Durable Medical Equipment Regional Carriers/PSCs/MACs I clicked "Cigna Government Services (18003, DME MAC)" which opened this page:
http://www.cms.gov/mcd/results_index.as ... er_range=4

I looked down through the alphabetically listed items to find Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (on page 2) and clicked "L11518."
There's also a link for "Oral Appliances for Obstructive Sleep Apnea" on the same page, btw.

That took me to Medicare Coverage Database
http://www.cms.gov/mcd/viewlcd.asp?lcd_ ... es+(18003):
(yes, that URL ends with a colon)

At the bottom of the page I had to click an "Accept" button before I could go further.

After clicking "Accept", this page opened:

LCD for Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L11518)
http://www.cms.gov/mcd/viewlcd.asp?lcd_ ... 2&show=all

Near the bottom of the page under "All Versions" this was mentioned:
Updated on 03/05/2010 with effective dates 04/01/2010 - 02/03/2011

In the "Jump to Section..." box up near the top of the page, I clicked Indications and Limitations of Coverage and/or Medical Necessity

Scrolled down the page and found Accessories and CPT/HCPCS Codes

Image


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Many (not all) private insurance companies use the same billing codes and replacement schedule as Medicare.
ResMed S9 VPAP Auto (ASV)
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
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Janknitz
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Joined: Sat Mar 20, 2010 1:05 pm
Location: Northern California

Re: Medicare - finding replacement schedule for your area

Post by Janknitz » Tue Jan 04, 2011 10:35 pm

Boy, they sure don't make it easy! Good sleuthing, RG.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm

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rested gal
Posts: 12881
Joined: Thu Sep 09, 2004 10:14 pm
Location: Tennessee

Re: Medicare - finding replacement schedule for your area

Post by rested gal » Wed Jan 05, 2011 1:07 am

Thanks, Jan.

You can imagine all the dead end trails on that little trek ...
ResMed S9 VPAP Auto (ASV)
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435

Janknitz
Posts: 8502
Joined: Sat Mar 20, 2010 1:05 pm
Location: Northern California

Re: Medicare - finding replacement schedule for your area

Post by Janknitz » Wed Jan 05, 2011 2:20 am

I'm guessing, after all your hard work, that the replacement schedules are the same for all of the DME MAC's. But it would be a PITA to find and compare all the schedules to be certain!
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm

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Catnapper
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Joined: Sun Oct 01, 2006 12:22 pm

Re: Medicare - finding replacement schedule for your area

Post by Catnapper » Wed Jan 05, 2011 4:03 pm

I was lucky I guess. I have an excellent DME, and they give me the list just about each time I get some supplies from them. The company is a small local firm providing only pulmonary supplies.

Catnapper - Joanie