What the heck? This thread is four and a half years old.......
Den
Insurance Not Covering APAP Machines?
Re: Insurance Not Covering APAP Machines?
Hi Den,
I agree it's old. Remember, nothing ever dies in cyberspace! I just laughed and went on.
Builta
I agree it's old. Remember, nothing ever dies in cyberspace! I just laughed and went on.
Builta
_________________
| Mask: Quattro™ FX Full Face CPAP Mask with Headgear |
| Additional Comments: Encore Pro, Backup-M Series BiPAP Auto. Set as ABiPAP 15I/9E AHI 0.2. Normally operates @ 12I/9E 1987 OSA diagnosis |
Last edited by builta on Mon Apr 11, 2011 4:19 am, edited 1 time in total.
If your never go off on a tangent, you are doomed to live your life going around in circles.
Re: Insurance Not Covering APAP Machines?
Yep, just some troll dredging it up - but just in case some of our newbies are mislead by some of the information posted in this thread .....
I know of no INSURANCE COMPANY that requires you to "fail" CPAP (HCPCS code e0601) before they will approve an APAP (HCPCS code e0601). Just another "less than the truth" that LOCAL DME PROVIDERS like to hand out to new, unsuspecting clients.
Do NOT confuse an APAP w/a BPAP or VPAP (bi-level HCPCS code e0470) as many insurances DO require you to "fail" CPAP before approving the cost & provision of a bi-level.
Here is a prime example of local DME provider "innovative" HCPCS coding:
http://www.icd9data.com/HCPCS/2011/E/default.htm
I know of no INSURANCE COMPANY that requires you to "fail" CPAP (HCPCS code e0601) before they will approve an APAP (HCPCS code e0601). Just another "less than the truth" that LOCAL DME PROVIDERS like to hand out to new, unsuspecting clients.
Do NOT confuse an APAP w/a BPAP or VPAP (bi-level HCPCS code e0470) as many insurances DO require you to "fail" CPAP before approving the cost & provision of a bi-level.
Here is a prime example of local DME provider "innovative" HCPCS coding:
You will find e1399 listed in the coding amongst Oxygen supplies such as oxygen concentrators.Guest wrote:... The DME company would then submit that LoMN along with the prescription for the autopap and a copy of the sleep study and other supporting documentation (CPAP trial reports, etc) to the Insurance Company.
That will often result in an insurance company approving a special authorization for an Auto-Pap under code E1399 (Miscellaneous). ...
Anyone wanting to check out what the HCPCS coding on your billings mean:...
E1354 Oxygen accessory, wheeled cart for portable cylinder or portable concentrat...
E1355 Stand/rack
E1356 Oxygen accessory, battery pack/cartridge for portable concentrator, any typ...
E1357 Oxygen accessory, battery charger for portable concentrator, any type, repl...
E1358 Oxygen accessory, dc power adapter for portable concentrator, any type, rep...
E1372 Immersion external heater for nebulizer
E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent...
E1391 Oxygen concentrator, dual delivery port, capable of delivering 85 percent o...
E1392 Portable oxygen concentrator, rental
E1399 Durable medical equipment, miscellaneous
E1405 Oxygen and water vapor enriching system with heated delivery
E1406 Oxygen and water vapor enriching system without heated delivery ...
http://www.icd9data.com/HCPCS/2011/E/default.htm
_________________
| Mask: Quattro™ FX Full Face CPAP Mask with Headgear |
| Additional Comments: PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2 Software - Contec CMS-50D+ Oximeter - Respironics EverFlo Q Concentrator |
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