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.