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Medicare and replacement schedule
#1
Medicare and replacement schedule
Can someone tell me what the normal time period is that is allowed for the different components before you can get them replaced?

I have AARP United Health Care.  They told me I could order from online suppliers and even ebay.  I just have to pay up front and they are supposed to cover 80%.  Not sure if they send me a check or if they credit that.

One question is I can get 12 filters on ebay for $12.  I used one a month so it would be a year supply.  I am wondering if the insurance co will realize that or if I need to do anything special.

Any other tips and knowledge as I get into this Medicare thing is appreciated as I'm sure I don't even know all the questions I need to ask at this point.
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#2
RE: Medicare and replacement schedule
You would have to submit an invoice that listed the correct Code.  Some online suppliers can supply the correct paper work, but don't know about ebay.

United States Medicare Replacement Schedule

A7034  CPAP Mask                      (Every 3 months)
A7035  CPAP Headgear               (Every 3-6 months)
A7036  CPAP Chin Strap              (Every 6 months)
A7037  CPAP Tubing                   (Every 3 months)
A7038  Disposable Filter              (2 new filters every month)
A7039  Non-disposable Filters      (1 new filter every 6 months)
A7030  Full Face Mask                 (Every 3 months)
A7029  Nasal Pillows                   (2 per month)
A7046  Humidifier Chamber        (Every 6 months)
E0601  CPAP                             Generally, 3 to 5 years.)

This is not a complete list, check with your individual insurance company.
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#3
RE: Medicare and replacement schedule
Thank you, I imagine cushion replacement for a FFM is once a month?

Will insurance automatically know these times or will my ARNP need need specify it on all prescriptions?  I ask because I'm certain my ARNP does not know this info Wink
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#4
RE: Medicare and replacement schedule
Your insurance will know.

Yes FFM cushion replacement is once a month.

You can save some $$ by replacing items less frequently. I am on my 3rd month with a FFM cushion and it still seems like new. Virtually everything listed will last much longer than the stated replacement intervals. I usually get a spare of everything in case of damage or premature failure and then just order as the need arises. I've used hoses and humidifier chambers for a year or more without replacement. The onlt thing I by per the schedule is filters. My copay is only $0.42 per filter so since it as easy to change it as check it, that's what I do. I may sometimes go a couple of months but there so cheap it doesn't matter.

I think you will find that most experienced users on the forum change much less frequently than the recommended schedule.
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#5
RE: Medicare and replacement schedule
Thank you for asking this. It's nice to see it spelled out.

How frequently are pillow-cushions allowed to be replaced?
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#6
RE: Medicare and replacement schedule
I'm allowed two per month.  I quess I have an excess of nasal pillows.   Eat-popcorn
OpalRose
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Medicare and replacement schedule
Throughout my 16+ years of CPAP I have been allowed one replacement FFM cushion per month. Last time around the DME told me that my insurance would only allow one every three months. My insurance is Medicare advantage which is supposed to follow Medicare guidelines as a minimum. I will be rattling the bars on somebody's cage to get to the bottom of this to see if this is legit or if the DME is misinformed.

Stan
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#8
RE: Medicare and replacement schedule
Yes, let us know what you find out.  It may be that they take into consideration that a full face mask cushion should last longer than nasal pillows.  That's just my guess.   Smile
OpalRose
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www.ApneaBoard.com


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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Medicare and replacement schedule
I have a Medicare advantage plan also. It allows for monthly cushion replacements. I think your DME has it wrong. I,m into the 4th month with the same F20 cushion, though, and it still seems fine.
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#10
RE: Medicare and replacement schedule
Wow! Ok. I'm going to lean harder on my DME, then. My P10 pillow stopped sealing well after a month, so I definitely need it replaced sooner.
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