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Heads Up Nano users on Medicare
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Lukie Offline

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Posts: 352
Joined: Nov 2013

Machine: Resmed S9 Auto
Mask Type: Full face mask
Mask Make & Model: Airfit F 10
Humidifier: H I heated tubing resmed
CPAP Pressure: 6-16
CPAP Software: ResScan SleepyHead

Other Comments: Masks: Simplus, Air, Quattro fx, Nano, Eson, Swift fx and Activ

Sex: Female
Location: Vermont

Post: #1
Heads Up Nano users on Medicare
Medicare has determined that the Nano nasal mask cushion is part of the frame and will only cover 1 replacement every three months.
I called ResMed and told them if they want people to use their mask they needed to make it clear to Medicare that the Nano mask is a cushion and should be replaced more often than every three months for health reasons.
It is not my DME but MEDICARE who has said that the Nano cushion is a frame and can only be replaced every three months.
01-31-2014 03:49 PM
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JohnNJ Offline

Preferred Members-2

Posts: 103
Joined: Oct 2013

Machine: ResMed S9 AutoSet & ResMed Power Station II
Mask Type: Nasal pillows
Mask Make & Model: Respironics Wisp & ResMed Swift FX
Humidifier: ResMed H5i & ClimateLine (distilled / fresh daily)
CPAP Pressure: 9.4 - 10
CPAP Software: ResScan SleepyHead

Other Comments: First night - November 25, 2013

Sex: Male
Location: New Jersey, USA

Post: #2
RE: Heads Up Nano users on Medicare
I just called Apria about the ResMed Swift FX Nano as it is viewed by Medicare. The cushion is part of the frame when you get the whole mask. It is not part of the frame when you get it separately.

Billing code A7034 - Entire mask

Billing code A7032 - cushion only (2 per month)
01-31-2014 04:10 PM
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Lukie Offline

Preferred Members-2

Posts: 352
Joined: Nov 2013

Machine: Resmed S9 Auto
Mask Type: Full face mask
Mask Make & Model: Airfit F 10
Humidifier: H I heated tubing resmed
CPAP Pressure: 6-16
CPAP Software: ResScan SleepyHead

Other Comments: Masks: Simplus, Air, Quattro fx, Nano, Eson, Swift fx and Activ

Sex: Female
Location: Vermont

Post: #3
RE: Heads Up Nano users on Medicare
Thanks I will forward this to my DME.
01-31-2014 05:02 PM
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JohnNJ Offline

Preferred Members-2

Posts: 103
Joined: Oct 2013

Machine: ResMed S9 AutoSet & ResMed Power Station II
Mask Type: Nasal pillows
Mask Make & Model: Respironics Wisp & ResMed Swift FX
Humidifier: ResMed H5i & ClimateLine (distilled / fresh daily)
CPAP Pressure: 9.4 - 10
CPAP Software: ResScan SleepyHead

Other Comments: First night - November 25, 2013

Sex: Male
Location: New Jersey, USA

Post: #4
RE: Heads Up Nano users on Medicare
Just another bit of info - they send me three months worth of supplies at a time so 6 cushions. I don't know if Medicare allows that but you should ask.
01-31-2014 05:10 PM
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Lukie Offline

Preferred Members-2

Posts: 352
Joined: Nov 2013

Machine: Resmed S9 Auto
Mask Type: Full face mask
Mask Make & Model: Airfit F 10
Humidifier: H I heated tubing resmed
CPAP Pressure: 6-16
CPAP Software: ResScan SleepyHead

Other Comments: Masks: Simplus, Air, Quattro fx, Nano, Eson, Swift fx and Activ

Sex: Female
Location: Vermont

Post: #5
RE: Heads Up Nano users on Medicare
Remember you are using the pillows. My DME will give me plenty of swift fx pillows I have a drawer full. It is the whole cushion of the nasal mask they don't want to replace more than 1 every three months.
01-31-2014 05:43 PM
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me50 Offline

Advisory Members

Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #6
RE: Heads Up Nano users on Medicare
(01-31-2014 05:43 PM)Lukie Wrote:  Remember you are using the pillows. My DME will give me plenty of swift fx pillows I have a drawer full. It is the whole cushion of the nasal mask they don't want to replace more than 1 every three months.

nasal cushions and nasal masks are the same in the replacement scheme of things....2 per month. the 3rd month when the hose/frame can be replaced, I am guessing they give the cushion, frame, and an additional cushion but I don't know for sure. It seems as though they should give an additional cushion on the months that you are allowed a new frame.
(This post was last modified: 01-31-2014 07:52 PM by me50.)
01-31-2014 07:50 PM
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Moriarty Offline

Advisory Members

Posts: 270
Joined: Jul 2012

Machine: Respironics REMStar 50 Series Auto
Mask Type: Nasal pillows
Mask Make & Model: Fisher & Pakel Pilairo Q
Humidifier: Respironics System One
CPAP Pressure: 8.5-20 (average 9.4)
CPAP Software: SleepyHead

Other Comments: Image above is my CPAP machine...

Sex: Male
Location: Toowoomba - Qld - Australia

Post: #7
RE: Heads Up Nano users on Medicare
I don't get why the Nano mask does not last longer.

Given that there is no ability to claim mask parts on any insurance in Australia I would not buy a mask with pillows/cushions that did not last for 12 months.

With careful use and daily cleaning my Pilairo cushions easily last 12 months.
02-01-2014 03:48 AM
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me50 Offline

Advisory Members

Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #8
RE: Heads Up Nano users on Medicare
(02-01-2014 03:48 AM)Moriarty Wrote:  I don't get why the Nano mask does not last longer.

Given that there is no ability to claim mask parts on any insurance in Australia I would not buy a mask with pillows/cushions that did not last for 12 months.

With careful use and daily cleaning my Pilairo cushions easily last 12 months.

it isn't about how long they last. the guidelines are in place to prevent potential infections, etc. and that is why it is allowed to change the nasal cushions/pillows twice per month. of course, just as with topping off the water tank, it is personal preference on how someone does this. It costs more but I order and use 2 cushions per month. If insurance pays for it then I will change them out.
02-01-2014 04:59 AM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #9
RE: Heads Up Nano users on Medicare
(02-01-2014 04:59 AM)me50 Wrote:  it isn't about how long they last. the guidelines are in place to prevent potential infections, etc.
What infections? I wash mine every day in soap and water
02-01-2014 05:18 AM
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me50 Offline

Advisory Members

Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #10
RE: Heads Up Nano users on Medicare
(02-01-2014 05:18 AM)zonk Wrote:  
(02-01-2014 04:59 AM)me50 Wrote:  it isn't about how long they last. the guidelines are in place to prevent potential infections, etc.
What infections? I wash mine every day in soap and water

glad that works well for you and others.

it isn't always enough though. just like there are many masks, cpap machines, etc., some people are more susceptible to infections, etc., and it is beneficial to do things to alleviate that possibility. If someone gets pneumonia, especially those with compromised immune systems and/or the elderly, it is harder to cure and some don't survive. Precaution is not a bad idea and each individual has the option to replace or not replace their supplies as often as allowed.

It is why people get flu and pneumonia shots, some take vitamins, etc. Not everyone has the same immune system.

As always, YMMV.
02-01-2014 05:30 AM
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