Replacement schedules/quanities for CPAP supplies with New York State medicaid?

Replacement schedules/quanities for CPAP supplies with New York State medicaid? - Printable Version

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Replacement schedules/quanities for CPAP supplies with New York State medicaid? - bdsc64 - 03-15-2022

Does any one know of a resource that would summarize the allowable replacement schedules/quantities for CPAP supplies with medicaid in New York State?

For the past five years I have received:

Every 2 weeks:
Mask cushions and/or nasal cushions
Disposable CPAP machine filters

Every 3 months:
Mask frame (not including the headgear)
CPAP tubing (heated or standard)

Every 6 months:
Mask headgear
Chin strap
Humidifier water chamber

I have searched and searched online. Medicaid office says there is an official amount (I am sure there must be!) but no one can actually find out what it is (I am still waiting for a callback form them).

I have been having a back and forth struggle with my DME (CrApria) on the amounts and frequency of replacement supplies.

My insurance company Healthfirst Managed Medicaid is not very helpful, and only says they will pay for whatever is "medically necessary".

Thanks

RE: Replacement schedules/quanities for CPAP supplies with New York State medicaid? - PurpleOx - 03-15-2022

Medicare is a federal program, so I don't think you need to find a NY-specific source.

https://www.google.com/url?sa=t&source=web&rct=j&url=https://oig.hhs.gov/oei/reports/oei-07-12-00250.pdf&ved=2ahUKEwiTwdqXlsn2AhVBl3IEHR2OACIQFnoECAQQAQ&usg=AOvVaw1gaq7Hfpt1LWLZj_cNuSOi

RE: Replacement schedules/quanities for CPAP supplies with New York State medicaid? - OpalRose - 03-15-2022

The OP is on Medicaid, and I believe each state runs their own program.

I do believe, however that Medicaid is supposed to follow the Medicare replacement schedule.

Here are a couple articles that may help. Not Medicaid or NY state Specific, but may help.

http://www.apneaboard.com/wiki/index.php/Dealing_with_a_DME

http://www.apneaboard.com/wiki/index.php/Dealing_with_insurance_%26_Medicare

By the way, you don't have to use Apria. You should have some other choices under Medicaid in NY state.

RE: Replacement schedules/quanities for CPAP supplies with New York State medicaid? - PurpleOx - 03-15-2022

Thanks OpalRose, I learn something new every day Smile

RE: Replacement schedules/quanities for CPAP supplies with New York State medicaid? - bdsc64 - 03-16-2022

In can anyone else come to this post looking for similar info:

I found what seems to be the current New York State medicaid guidelines for allowed quantities and frequency CPAP supplies. It is the "DME_Fee_Schedule" spreadsheet https://www.emedny.org/ProviderManuals/ ... hedule.xls

which is found on from the site https://www.emedny.org/ProviderManuals/DME/index.aspx

Please note, as per the document
https://www.emedny.org/ProviderManuals/ ... ptions.pdf
that the “MAX UNITS” column is “for medical/surgical supplies, the maximum allowed per month”.

RE: Replacement schedules/quanities for CPAP supplies with New York State medicaid? - bdsc64 - 03-16-2022

(03-15-2022, 05:41 PM)OpalRose Wrote: The OP is on Medicaid, and I believe each state runs their own program.

I do believe, however that Medicaid is supposed to follow the Medicare replacement schedule.

Here are a couple articles that may help. Not Medicaid or NY state Specific, but may help.

http://www.apneaboard.com/wiki/index.php/Dealing_with_a_DME

http://www.apneaboard.com/wiki/index.php/Dealing_with_insurance_%26_Medicare

By the way, you don't have to use Apria. You should have some other choices under Medicaid in NY state.

Thank you for your reply and for the links/info! Thanks

RE: Replacement schedules/quanities for CPAP supplies with New York State medicaid? - SarcasticDave94 - 03-16-2022

This applies to PA where I reside, while waiting on Disability to be approved, I was on Medicaid through United Healthcare. Their schedule was identical to Medicare. For the DME selection, I was expected to use a national, Apria, Rotech, or Lincare. If I recall correctly, I had to go via an exemption to get a different DME selection approved. Hint, impossible to get it. And I had to use a DME billing office within my state.