Insurance Reimbursement

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.

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

NOTE: Patient Sleep Supplies 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 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.

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

A7027 - Oral/Nasal (Hybrid) Mask

A7028 - Oral Cushion for Hybrid Mask

A7029 - Nasal Cushion for Hybrid Mask

E1399 - CPAP Miscellaneous
 

Physician Diagnosis Code

A Physician Diagnosis Code is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim. Some insurance companies may require you to include a code that is associated with your diagnosis.

The code for Obstructive Sleep Apnea (OSA) is G47.33 however, 327.23 should be used for claims with a date of service on or before September 30, 2015. Use G47.33 for claims with a date of service on or after October 1, 2015.

 

1415 Lawrence Drive . Newbury Park, CA 91320 . US . 877.823.9310 . info@patientsleepsupplies.com