CPAP HCPCS Codes

 In CPAP Insurance, Most Popular Posts, Sleep Apnea

Are you curious whether or not your CPAP supplies are covered by insurance?  Look no further, as Health Sqyre is here to help!  Any CPAP supply item covered by insurance will have a Healthcare Common Procedure Coding System (HCPCS), or CPAP HCPCS, number.  Moreover, each ‘category’ of CPAP products has its own reimbursement schedule.  You should utilize this schedule correctly with your current insurance plan to save you tons of money!

The following table shows Medicare’s reimbursement schedule.  Most major insurance companies, such as Aetna, Blue Cross Blue Shield (BCBS), Humana, and more will follow this schedule:

List / Schedule of CPAP HCPCS Codes

Code Description

CPAP HCPCS

Usual Maximum

Heated Tubing A4604 1 per 3 months
Hybrid Mask A7027 1 per 3 months
Replacement Hybrid Mask Cushion A7028 2 per 1 month
Replacement Hybrid Mask Nasal Pillow A7029 2 per 1 month
Full Face Mask A7030 1 per 3 months
Replacement Full Face Mask Cushion A7031 1 per 1 month
Replacement Nasal Mask Cushion A7032 2 per 1 month
Replacement Nasal Pillow A7033 2 per 1 month
Nasal Pillow Mask A7034 1 per 3 months
Headgear A7035 1 per 6 months
Chinstrap A7036 1 per 6 months
Tubing A7037 1 per 3 months
Disposable Filter A7038 2 per 1 month
Non-disposable Filter A7039 1 per 6 months
Oral Interface Mask A7044 1 per 3 months
Replacement Humidifier Chamber A7046 1 per 6 months
BiPAP Machine E0470 1 per 5 years
BiPAP Auto Machine E0471 1 per 5 years
Non-heated CPAP Humidifier E0561 1 per 5 years
Heated CPAP Humidifier E0562 1 per 5 years
CPAP Machine E0601 1 per 5 years


Pro tip: If you have any questions about how specific aspects of insurance, like deductibles, co-insurance rates, etc., 
check out Health Sqyre’s Guide to Insurance.

 

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