If you’re wondering if your CPAP supplies are covered by insurance; the answer is: most of them. Dealing with insurance companies isn’t easy. While most CPAP supply companies can bill your insurance company for you and in cases where patients are using Medicare, CPAP supply companies are the only ones allowed to do so, you may find yourself in a situation where you have to bill your insurance company. Here’s a quick how-to guide to help.
The first thing you’ll need to do is get ahold of your insurance company, and contact the department in charge of member services personally to make sure that they have a process for you, as a subscriber, to submit a claim for out of pocket medical expenses (the CPAP supplies you’ve purchased). Once you’ve contacted your insurance company’s representative, be certain to find out what specific kind of form is required for you to fill out your claim submission information. Some companies do allow you to use an almost universal document called a Health Insurance Claim Form that is available for download online. Complete the required form, and make sure to include any and all of the billing information the insurance companies need to process your claim (these are standardized). Always include a copy of your own invoice to the paperwork you’re submitting. You will need to separate the CPAP supplies you’ve ordered into the proper HCPCS billing codes.. Masks, for example, typically come with headgear, the cost of which needs to be split, because the insurance company generally processes the price of headgear, and of the CPAP mask separately. When invoicing your insurance company, you need to separate these costs yourself. In general, the CPAP mask itself typically comprises 70% of the overall cost, and the headgear itself is the remaining 30%.
Submit the insurance claim form, with the invoice attached, to the insurance company however they’ve asked you to. In most cases, they require you use standard U.S. mail; however, some will accept a fax. Now, you just have to wait patiently for reimbursement. For the most part, insurance companies claim to be able to complete their claims within thirrty business days, but you’ll want to inquire about your company’s turnaround time, just to be sure.
These are some of the standard HCPCS Billing Codes for CPAP supplies. They are what insurance companies use when processing claims. Make sure to use the proper code on the claim form, and separate and itemize each item on the invoice:
- A7034 - nasal mask
- A7032 - nasal cushion
- A7033 - nasal pillows
- A7030 - Full Face mask
- A7031 - Full Face cushion
- A7037 - tubing, both long and short hoses
- A7038 - disposable filter
- A7039 - washable foam filter
- K0553 - Hybrid Mask
- K0554 - Oral Cushion for Hybrid Mask
- E1399 - Miscellaneous (to be used for any CPAP supplies your insurance covers that aren’t listed.
Insurance companies also need you to provide the code for the specific diagnosis. For Obstructive Sleep Apnea, the code is 327.23.
