Medicare allowable charge?

I have not spent any money towards my Medicare deductible for the year, so I will have to pay whatever the Medicare allowable charge is for my CPAP equipment. Does anyone know where I can find a list of what Medicare will allow me to be charged for mask, headgear, cushions and heated hose? I know that there was one floating around online years ago. The home health company said that they didn't know.

Do you have original medicare? This may have what you want to know, good luck figuring it out...

https://www.cms.gov/Medicare/Medicare-F ... descending

Yes, I have original Medicare. Thanks for the link, but I was not able to make sense of all of the files that I downloaded. I live in Wisconsin. Is there an easy way to figure out the amount allowed by Medicare?

Have you tried calling Medicare and asking? Other than those files, I don't know. Sorry.

Here's what I could find...

Check this list for the codes:
https://www.directhomemedical.com/direc ... -page.html

Then match the codes to the fee on this list:

https://www.cgsmedicare.com/medicare_dy ... esults.asp

Of course only Medicare really knows.

And Medicare reserves the right to change anything at any time--for any reason they choose.
Just call Medicare and ask.
Plug your phone into the charger.
I think they know when your phone is dying.

chunkyfrog wrote: ↑

Sat Jan 26, 2019 9:11 pm

And Medicare reserves the right to change anything at any time--for any reason they choose.
Just call Medicare and ask.
Plug your phone into the charger.
I think they know when your phone is dying.

If you don't like the answer you get, just call the same number someone else will answer the phone, ask them the same questions, and get another different set of answers. Pick the ones you like best. Jim

CpapUser100 wrote: ↑

Fri Jan 25, 2019 10:38 pm

I have not spent any money towards my Medicare deductible for the year, so I will have to pay whatever the Medicare allowable charge is for my CPAP equipment. Does anyone know where I can find a list of what Medicare will allow me to be charged for mask, headgear, cushions and heated hose? I know that there was one floating around online years ago. The home health company said that they didn't know.

I can't help you with the chart, but during 2018 I received 2 items from Medicare. A complete FF mask..Medicare allowed $80.87 and a Slimline hose Medicare allowed $14.50...I have a Medicare complete plan and paid 20% of these amounts. I have no deductable.

With regard to the Medicare website billing info, I spent over an hour yesterday sorting it out.
I attempted to copy and paste the relevant portion here for you, but the copy expanded all the info that I had hidden because it was irrelevant and made the post irrelevant so I didn't post it.

What I did is download the file for my favorite spreadsheet.
Next I hid all the columns for states other than my state of California and your state of Wisconsin.
Then I hid the rows that contained the info I didn't care about.
Now I had a one page view of all the PAP related equipment I could find.
next was a guessing game as to which items were actual purchase price and which were monthly rental fees.

Once I had accomplished this, I had to leave for work. today my saved file had lost all my formatting, so I will leave it to you and others to decipher my ramblings and the cost charts.

Do you have a Medicare Supplement plan? Your Medicare supplement plan should take care of some or all of the deductible and co-pays (not always, depending on your plan). But you need to check with your supplement plan because they may only cover the deductibles and co-pays if you use an authorized vendor.

Keep in mind that "balanced billing"--charging you the difference between the insurer allowed amount if you use a contracted DME and the fantasy retail amount the DME would like to charge you is illegal in most states and a violation of the contract most DME's have with Medicare Supplement plans.

If you don't have a decent supplement plan, be sure to use a Medicare contracted provider so that they cannot charge you more than the Medicare contracted amount.

Good explanation in plain English here but not about the specific out of pocket costs:
https://www.cms.gov/Outreach-and-Educat ... yGuide.pdf

You can also get (more reliable) info from your State Health Insurance Program or HICAP--free Medicare counseling and advocacy. Their number is on the back of your Medicare and You booklet or you can find it on Medicare.gov for your state.

chunkyfrog wrote: ↑

Sat Jan 26, 2019 9:11 pm

And Medicare reserves the right to change anything at any time--for any reason they choose.
Just call Medicare and ask.
Plug your phone into the charger.
I think they know when your phone is dying.

I spent more than 2 hours on the phone with Medicare yesterday if you include hold times and my battery got down to 21%. Eventually I got someone who told me that they did not have any info available for the codes I gave them and that my doctor or home health provider would have to call Medicare to get pricing from another department because that department was not allowed to talk to patients.

I eventually got info from the home health company but I am not sure if the info is correct.

It is really shocking how difficult it is to get basic info.

bwexler wrote: ↑

Sun Jan 27, 2019 2:16 pm

With regard to the Medicare website billing info, I spent over an hour yesterday sorting it out.
I attempted to copy and paste the relevant portion here for you, but the copy expanded all the info that I had hidden because it was irrelevant and made the post irrelevant so I didn't post it.

What I did is download the file for my favorite spreadsheet.
Next I hid all the columns for states other than my state of California and your state of Wisconsin.
Then I hid the rows that contained the info I didn't care about.
Now I had a one page view of all the PAP related equipment I could find.
next was a guessing game as to which items were actual purchase price and which were monthly rental fees.

Once I had accomplished this, I had to leave for work. today my saved file had lost all my formatting, so I will leave it to you and others to decipher my ramblings and the cost charts.

That was so nice of you! I really appreciate all of the time you put into it. Sorry your file lost it's formatting.

What equipment are you looking for? You can often find items at Amazon or on eBay for less than the DME charges. You are going to need to pay the $185 part B deductible some time during the year and items purchased from Amazon or eBay will not count towards this deductible.

Okie bipap wrote: ↑

Tue Jan 29, 2019 2:05 pm

What equipment are you looking for? You can often find items at Amazon or on eBay for less than the DME charges. You are going to need to pay the $185 part B deductible some time during the year and items purchased from Amazon or eBay will not count towards this deductible.

Yes, I've seen great prices on Amazon and Ebay. I am trying to figure out if it is cheaper to buy through Amazon and Ebay or to go through Medicare for my mask, headgear, and cushions in the long run. That's why I wanted to know how much Medicare would allow me to be charged. They don't make it easy to compare!

I have a new primary insurance that has a $500 deductible that my CPAP equipment is subject to. For probably the past 5 or 6 years I had 90% of my CPAP supplies covered with no deductible, so this is a huge change. If I buy out of pocket, I am hoping to not even hit the $185 Medicare Part B deductible this year.

CpapUser100 wrote: ↑

Tue Jan 29, 2019 4:54 pm

Okie bipap wrote: ↑

Tue Jan 29, 2019 2:05 pm

What equipment are you looking for? You can often find items at Amazon or on eBay for less than the DME charges. You are going to need to pay the $185 part B deductible some time during the year and items purchased from Amazon or eBay will not count towards this deductible.

Yes, I've seen great prices on Amazon and Ebay. I am trying to figure out if it is cheaper to buy through Amazon and Ebay or to go through Medicare for my mask, headgear, and cushions in the long run. That's why I wanted to know how much Medicare would allow me to be charged. They don't make it easy to compare!

I have a new primary insurance that has a $500 deductible that my CPAP equipment is subject to. For probably the past 5 or 6 years I had 90% of my CPAP supplies covered with no deductible, so this is a huge change. If I buy out of pocket, I am hoping to not even hit the $185 Medicare Part B deductible this year.

You have Primary Insurance and Medicare?