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How to Bill Insurance

How to Receive Reimbursement for CPAP Expenses by Your Health Insurance Provider

While we do not bill private insurance companies for the cost of your CPAP supplies, you can submit a request for reimbursement to your insurance company to cover your out-of-pocket costs. To help our patients with this process, we have outlined some instructions on how to file an insurance claim on your behalf for both CPAP and BiPAP supplies.

 

NOTE: Medicare recipients cannot submit claims for reimbursement on their own behalf. All Medicare claims need to be billed form an equipment company that contains a Medicare provider number.

 

Also NOTE: Our organization can only provide you with basic instructions on how to submit reimbursement. We are not responsible for determining the procedures and policies that insurance companies follow, so the accuracy of this information can not be guaranteed for your specific health insurance policy. Please ensure that you verify any information you’re your insurance company before you submit a claim.

 

Instructions

  • Contact your insurance company’s member services department to ensure that they will allow you to submit a claim for out-of-pocket medical expenses.
  • While speaking to your insurance representative, ask them what type of information they need regarding your claim. While some insurance companies may allow you to complete a generic claim form, others may have specific forms they want you to submit.
  • Complete the required form and be sure to including qualifying and billing information that your insurance company will need to process the claim.
  • Include a copy of your invoice with your form. The supplies ordered will likely need to be split up based on their appropriate billing codes. For example, some insurance companies may require that the cost of a CPAP mask and mask headgear be processed separately.
  • Submit your invoice and claim form to your insurance in the manner that they request, which will most commonly be by fax or mail.
  • Wait for your reimbursement. This will vary by company, but most insurance companies will issues claim reimbursements within 30 days.

 

HCPCS Billing Codes

The following codes are used to process claims by insurance companies. To best ensure that your claim is processed in a timely manner, please use the code that is most appropriate. Codes should also correspond to each individual item that you are listing on your invoice. Items including CPAP batteries, bed pillows, and adapters are not typically covered, as they are commonly considered luxury items.

E0601 - CPAP machine purchase
A7034 - CPAP nasal mask
A7032 - CPAP nasal mask cushion
A7030 - CPAP Full Face mask
A7031 - CPAP Full Face mask cushion
A7044 - CPAP Full Oral Interface
A7046 - CPAP Humidifier Chamber
A7037 - CPAP tubing, long and short hoses
A7038 - CPAP disposable filter
A7039 - CPAP foam filter
A7035 - CPAP headgear
A7033 - CPAP nasal pillows
A7036 - CPAP chinstrap
E0561 - CPAP Passover Humidifier
E0562 - CPAP Heated Humidifier
E0470 - BiPAP purchase
E0471 - BiPAP-ST purchase
A4604 - Thermo Smart Tube
K0553 - Oral/Nasal (Hybrid) Mask
K0554 - Oral Cushion for Hybrid Mask
K0555 - Nasal Cushion for Hybrid Mask
E1399 - CPAP Miscellaneous

Physician Diagnosis Code

 

Some insurance companies may also require you to include a code that is associated with your diagnosis. The code for Obstructive Sleep Apnea (OSA) is 327.23.