Medicare and Suplies - Nasal Masks

Three months ago my DME gave me a nasal mask w/ pillow. Medicare paid most of the cost.
But it is leaking and I would like to try something else. So I asked for the TAP PAP Nasal Pillow.
But was told that I would have to wait another 3 months.

And I don't understand it. The TAP PAP does not have a headgear and that is the only thing which would need a 6 mo wait under Medicare rules.
So, is it possible that the DME is in error?

Some of the original Tap Pap mask packages did include the headgear as it was an option. When I first bought my Tap Pap the headgear was included but never used.
It is now offered without the headgear. It is less expensive and since the headgear was never used...a nice thing to not have to pay for something that I didn't use.

Most likely your DME doesn't want to accept the reimbursement rate for the mask interface option that is allowed at 3 months, that doesn't include headgear, is the real reason they are telling you that you have to wait.

https://www.cpap.com/productpage/tap-pa ... roved.html

Technically you could push your DME on this issue but I don't know if you will get anywhere with them. If they stock them they may have some of the older packages that include the headgear. If they don't stock them they may simply not want to bother ordering just one. My DME won't even order one for me. Tried and tried but they just won't do it.
Medicare reimburses a set amount for the billing code used for 3 month mask interface that doesn't include the headgear and the DME may not make enough money on it to suit them. My DME told me that I can buy it cheaper online than they can and with Medicare reimbursement rate they lose money...well, not exactly true but they sure don't make much and not enough to make it worth their while.

A7034 would the code to be used for nasal interface mask that is allowed 1 per 3 months that doesn't include headgear.
Medicare allows somewhere between $94 and $110 (varies between regions) for that billing code
Headgear is A7035 and varies between $31 and $37
For some DMEs...that's not enough money for the work involved and if they can't buy the Tap Pap for less than what Medicare allows for it....they aren't going to do it. Plus some simply won't do the 3 month coded choice...they just won't. Mine won't. and there's nothing that forces any DME to do it. They simply don't have to stock everything if they don't want to.

I have the fee schedule for 2014 but PITA to post each item. But numbers above I just now got from the big pdf that includes all DME equipment. Allowable amounts will vary within region but past experience has shown that most of the time the minimum is what gets allowed....at least in my region.

But here is the allowable replacement chart.