Change to DME benefit limits for apnea monitors, respiratory, oxygen, and ventilators

Apnea monitors, respiratory, oxygen, and ventilators

HCPCS code

Description

Billing unit

Limit

Apnea monitor lead wires

A4556

Electrodes (for example Apnea monitor)

Pair

15/month

A4557

Apnea monitor lead wires

Pair

1/3 months

E0618

Apnea Monitor without recording feature

Each

1/60 months

E0619

Apnea Monitor with recording feature

Each

1/60 months

Respiratory/oxygen/ventilators

A4481

Work with Ron McMahan to get a provider term letter from 2022 and 2023 that was sent to member within 30 days of provider term filter, any type, any size, each

Each

65/month

A4483

Moisture exchanger, disposable, for use with invasive mechanical ventilation

Each

20/month

A4604

Tubing with integrated heating element for use with positive airway pressure device

Each

1/month

A4605

Tracheal suction catheter, closed system, each

Each

31/month

A4606

Oxygen probe for use with oximeter device, replacement

Each

6/month

A4608

Transtracheal oxygen catheter, each

Each

*5/month

A4614

Peak expiratory flow rate meter, handheld

Each

1/6 months

A4615

Cannula, nasal

Each

5/month

A4616

Tubing, Oxygen

1 Feet

30/month

A4617

Mouthpiece

Each

1/month

A4618

Breathing circuits

Each

15/month

A4619

Face Tent

Each

5/month

A4620

Variable Concentration Mask

Each

5/month

A4623

Tracheostoma Inner Cannula Replacement

Each

65/month

A4624

Tracheal suction catheter, any type other than closed system, each

Each

120/month

A4625

Tracheostomy care kit for new tracheostomy

Each

31/month

A4626

Tracheostomy cleaning brush, each

Each

2/month

A4627

Spacer, bag, or reservoir, with or without mask, for use with metered dose inhaler

Each

1/12 months

A4628

Oropharyngeal suction catheter,

Each

5/month

A4629

Tracheostomy care kit for established tracheostomy

Each

31/month

A7000

Canister, disposable, used with suction pump

Each

12/12months

A7001

Canister, non-disposable, used with suction pump, each

Each

4/12months

A7002

Tubing, used with suction pump, each

10 Ft.

5/month

A7003

Administration set, with small volume nonfiltered pneumatic nebulizer, disposable

Each

5/month

A7004

Small volume nonfiltered pneumatic nebulizer, disposable

Each

*20/month

A7005

Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable

Each

1/6 months

A7006

Administration set, with small volume filter pneumatic nebulizer

Each

1/month

A7007

Large volume nebulizer, disposable, unfilled, used with aerosol compressor

Each

5/month

A7008

Large volume nebulizer, disposable, Prefilled, used with aerosol compressor

Each

120/month

A7009

Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer

Each

5/month

A7010

Corrugated tubing, disposable, used with large volume nebulizer, 100 ft

100 Ft

5/month

A7012

Water collection device, used with large volume nebulizer

Each

1/60 months

A7013

Filter, disposable, used with aerosol compressor

Each

12/12months

A7014

Filter, non-disposable, used with aerosol compressor or ultrasonic generator

Each

4/12months

A7015

Aerosol mask, used with DME nebulizer

Each

4/month

A7016

Dome and mouthpiece, used with small volume ultrasonic nebulizer

Each

1/month

A7018

Water, distilled, used with large volume nebulizer, 1000 ml

Each

15/month

A7020

Interface for cough stimulating device, includes all components, replacement only

Each

1/6 months

A7025

High-Frequency chest wall oscillation system vest, replacement for with patient owned equipment, each

Each

1/24 months

A7026

High Frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each

Each

1/24 months

A7027

Combination oral/nasal mask, used with continuous positive airway pressure device, each

Each

3/12 months

A7028

Oral cushion for combination oral/nasal mask, replacement only, each

Each

3/12 months

A7029

Nasal pillows for combination oral/nasal mask, replacement only, each

Each

3/12 months

A7030

Full face mask used with positive airway pressure device, each

Each

3/12 months

A7031

Face mask interface, replacement for full face mask, each

Each

3/12 months

A7032

Replacement cushion for nasal application device, each

Each

3/12months

A7033

Replacement Pillows for nasal application device

Pair

3/12 months

A7034

Nasal interface (mask or cannula type) used w/positive airway pressure device, w/or w/out head strap

Each

3/12 months

A7035

Headgear used with positive airway pressure device

Each

3/12 months

A7036

Chinstrap used with positive airway pressure device

Each

3/12 months

A7037

Tubing used with positive airway pressure device

Each

3/12 months

A7038

Filter, disposable, used with positive airway pressure device

Each

1/month

A7039

Filter, non-disposable, used with positive airway pressure device

Each

1/month

A7044

Oral interface used with positive airway pressure device, each

Each

3/12 months

A7045

Exhalation port with or without swivel used with accessories for positive airway devices, replacement only

Each

3/12 months

A7046

Water chamber for humidifier, used with positive airway pressure device, replacement, each

Each

1/month

A7047

Oral interface used with respiratory suction pump, each

Each

3/12 months

A7501

Tracheostoma valve, including diaphragm, each

Each

1/month

A7502

Replacement diaphragm/faceplate for tracheostoma valve, each

Each

1/month

A7503

Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each

Each

1/6 months

A7504

Filter for use in a tracheostoma heat and moisture exchange system, each

Each

65/month

A7505

Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each

Each

2/3 month

A7506

Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, any type, each

Each

65/month

A7508

Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/ or with a tracheostoma valve, each

Each

65/month

A7509

Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each

Each

65/month

A7507

Filter holder and integrated filter without adhesive, for use in tracheostoma heat and moisture exchange system, each

Each

65/month

A7520

Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (PVC), silicone or equal, each

Each

3/ month

A7521

Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (PVC), silicone or equal, each

Each

3/ month

A7522

Tracheostomy/laryngectomy tube, stainless steel or equal, (sterilizable and reusable), each

Each

1/ month

A7524

Tracheostomy stent/stud/button, each

Each

1/3 months

A7525

Tracheostomy Mask

Each

5/month

A7526

Tracheostomy tube collar/holder, each

Each

31/month

A7527

Tracheostomy/laryngectomy tube plug/stop, each

Each

2/3 month

E0430

Portable Gaseous Oxygen System, purchase, Includes Regulator, flowmeter, humidifier, cannula or mask, and tubing

Each

12/ months

E0435

Portable liquid oxygen system, purchase, includes portable container, supply reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing, and refill adapter

Each

12/ months

E0441

Stationary oxygen contents, gaseous, 1 month supply = 1 unit

1 Unit

12 months

E0442

Stationary oxygen contents, liquid, one month’s supply = 1 unit

1 Unit

1/ month

E0443

Portable oxygen contents, gaseous one month’s supply = 1 unit

1 Unit

1/month

E0444

Portable oxygen contents, liquid, one month's supply = 1 unit

1 Unit

1/month

E0447

Portable oxygen contents, liquid, one month's supply = 1 unit, prescribed amount at rest or nighttime exceeds 4 liters per minute (lpm)

1 Unit

1/month

E0445

Oximeter device for measuring blood oxygen levels, non-invasively

Each

1/60 months

E0465

Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube)

Each

1/60 months

E0466

Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell)

Each

1/60 months

E0467

Home Ventilator, multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components and supplies for all functions

Each

1/60 months

E0455

Oxygen Tent, Excluding Croup Or Pediatric Tents

Each

2/month

E0457

Chest shell (cuirass)

Each

1/60 months

E0460

Negative pressure ventilator, portable or stationary

Each

1/60 months

E0470

Respiratory Assist Device, bi-level pressure capability, w/out backup rate feature, used w/noninvasive interface e.g., nasal or facial mask.

Each

1/36 months

E0471

Respiratory assist device, bi-level pressure capability, w/backup rate feature, used w/noninvasive interface, e.g., Nasal or facial mask

Each

1/36 months

E0472

Respiratory Assist Device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)

Each

1/36 months

E0480

Percussor, Electric or Pneumatic, Home Model

Each

1/60 months

E0482

Cough stimulating device

Each

1/60 months

E0483

High frequency chest wall oscillation system, with full anterior and/or posterior region receiving simultaneous external oscillation, includes all accessories and supplies, each

Each

1/60 months

E0500

IPPB Machine, all types, w/built-in nebulization; manual or automatic valves; internal or external power source

Each

1/60 months

E0561

Humidifier, non-heated, used with positive airway pressure device

Each

1/36 months

E0562

Humidifier, heated, used with positive airway pressure device

Each

1/60 months

E0565

Compressor, air power source for equipment which is not self-contained, or cylinder driven

Each

1/36 months

E0570

Nebulizer, with compressor

Each

1/36 months

E0575

Nebulizer, Ultra-Sonic large volume

Each

1/36 months

E0580

Nebulizer, w/compressor, durable, glass or autoclavable plastic, bottle type, for us w/regulator or flowmeter

Each

1/36 months

E0600

Respiratory suction pump, home model, portable or stationary, electric

Each

2/36 months

E0601

Continuous Positive Airway Pressure (CPAP) Device

Each

1/36 months

E0606

Postural Drainage Board/Reflux Wedge

Each

1/60 months

E1352

Oxygen accessory, flow regulator capable of positive inspiratory pressure

Each

1/36 months

E1353

Regulator

Each

1/60 months

E1355

Stand/Rack

Each

1/36 months

E1372

Immersion external heater for nebulizer

Each

1/60 months

L8501

Tracheostomy Speaking Valve

Each

6/12 months

S8096

Portable peek flow meter

Each

2/12 months

S8120

Oxygen contents, gaseous, 1 unit equals 1 cubic foot

Each

*4/month

S8121

Oxygen contents, liquid, 1 unit equals 1 pound

Each

*300/month

S8999

Resuscitation bag (for use by patient on artificial respiration during power failure or other catastrophic event)

Each

4/12 months

*Denotes DMAS IC code, the limit is set by HealthKeepers, Inc.