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.
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.
E0601 - CPAP machine purchase
A7034 - CPAP nasal mask
A7032 - CPAP nasal mask cushion
A7030 - CPAP Full Face mask
A7031 - CPAP Full Face mask cushion
A7044 - CPAP Full Oral Interface
A7046 - CPAP Humidifier Chamber
A7037 - CPAP tubing, long and short hoses
A7038 - CPAP disposable filter
A7039 - CPAP foam filter
A7035 - CPAP headgear
A7033 - CPAP nasal pillows
A7036 - CPAP chinstrap
E0561 - CPAP Passover Humidifier
E0562 - CPAP Heated Humidifier
E0470 - BiPAP purchase
E0471 - BiPAP-ST purchase
A4604 - Thermo Smart Tube
A7027 - Oral/Nasal (Hybrid) Mask
A7028 - Oral Cushion for Hybrid Mask
A7029 - Nasal Cushion for Hybrid Mask
E1399 - CPAP Miscellaneous
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.