Insurance Reimbursement
How to Receive Reimbursement by Your Health Insurance Provider
While we do not bill private insurance companies for the cost of your 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.
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: Gold Coast Medical 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.
CPAP/BiPAP MACHINE INSURANCE (HCPCS) CODES
E0601 | Continuous airway pressure (CPAP/APAP) device |
E0470 | Respiratory assist device, bi-level pressure (BiPAP) capability, WITHOUT backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
E0471 | Respiratory assist device, bi-level pressure (BiPAP) capability, WITH backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
E0472 | Respiratory assist device, bi-level pressure (BiPAP) capability, WITH backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device) |
E0561 | Humidifier, non-heated, used with positive airway pressure (CPAP/BiPAP/APAP) device |
E0562 | Humidifier, heated, used with positive airway pressure (CPAP/BiPAP/APAP) device |
CPAP/BiPAP MASK INSURANCE (HCPCS) CODES
A7030 | Full Face Mask used with Positive Airway Pressure (CPAP/BiPAP/APAP) Device |
A7034 | Nasal interface (mask or cannula type) used with positive airway pressure (CPAP/BiPAP/APAP) device , with or without headstrap |
A7044 | Combination oral/nasal mask, used with continuous positive airway pressure device |
A7027 | Combination oral/nasal mask, used with continuous positive airway pressure device |
CPAP/BiPAP PART & ACCESSORY INSURANCE (HCPCS) CODES
A7028 | Replacement Oral Cushion for Combination Oral / Nasal Mask |
A7029 | Replacement Nasal Pillows Cushion for Combination Oral / Nasal Mask |
A7031 | Replacement Cushion for Full Face Mask |
A7032 | Replacement Cushion for Nasal Mask |
A7033 | Replacement Pillows for Nasal Pillows or Cannula Style Mask |
A7035 | Headgear used with positive airway pressure device |
A7036 | Chinstrap used with positive airway pressure device |
A7037 | Tubing used with positive airway pressure device |
A4604 | Heated Tubing used with positive airway pressure device |
A7038 | Filter, disposable, used with positive airway pressure device |
A7039 | Filter, non-disposable (reusable), used with positive airway presssure device |
A7045 | Exhalation port with or without swivel used with accessories for positive airway pressure devices |
A7046 | Water chamber for humidifier, used with positive airway pressure device |
E1399 | Miscellaneous Durable Medical Equipment Items, Components and Accessories |
NEBULIZER & COMPRESSOR INSURANCE (HCPCS) CODES
E0570 | Nebulizer, with compressor |
A7005 | Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
A7004 | Small volume nonfiltered pneumatic nebulizer, disposable |
A7003 | Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
A7015 | Aerosol mask, used with dme nebulizer |
A7014 | Filter, nondisposable, used with aerosol compressor or ultrasonic generator |
A7013 | Filter, disposable, used with aerosol compressor or ultrasonic generator |
A4627 | Chamber, with or without mask, for use with metered dose inhaler |
LIGHT THERAPY DEVICE INSURANCE (HCPCS) CODES
E0203 | Light Therapy Device |
COMMON SLEEP & OXYGEN THERAPY DIAGNOSIS CODES (ICD10)
G47.30 | Sleep Apnea (Unspecified) |
G47.31 | Primary Central Sleep Apnea |
G47.33 | Obstructive Sleep Apnea (Adult) (Pediatric) |
G47.37 | Central Sleep Apnea in Conditions Classified Elsewhere |
G47.39 | Other Sleep Apnea |
J44.0 | Chronic Obstructive Pulmonary Disease (COPD) with Acute Lower Respiratory Infection |
J44.1 | Chronic Obstructive Pulmonary Disease (COPD) with (Acute) Exacerbation |
J44.9 | Chronic Obstructive Pulmonary Disease (COPD) (Unspecified) |
J45.20 | Mild Intermittent Asthma (Uncomplicated) |
J45.30 | Mild Persistent Asthma (Uncomplicated) |
J45.40 | Moderate Persistent Asthma (Uncomplicated) |
J45.50 | Severe Persistent Asthma (Uncomplicated) |
J45.901 | Unspecified Asthma with (Acute) Exacerbation |
J45.909 | Unspecified Asthma (Uncomplicated) |
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.
