Health insurance is an essential component of a person’s health expenditure plan for treating any ailment and sleep apnea is no exception. Sleep apnea is a chronic condition which requires treatment throughout the person’s lifespan, and health insurance is essential since he would require CPAP machine along with supplies and essentials throughout his lifetime.
Several insurance companies, to tap into this vast potential market, have started offering coverage for CPAP treatment, though the degree of coverage varies. There are three major types of insurance providers which cater to this market, namely – government providers, provider networks, and private providers.
Government Providers
Ensuring good healthcare and proper treatment facilities for every citizen is one of the leading priorities of any government. The US federal government offers various medical insurance programs for qualified citizens. For example, Medicare is provided to US citizens who are aged 65 and above.
This program is also applicable for younger citizens who have specific disabilities. Medicaid is another government insurance program which aims at providing healthcare to families as well as individuals coming from the low-income strata. For citizens working in the armed forces as well as military, the government offers TriCare health insurance scheme.
Provider Networks
Insurance plans offered by provider networks provide a way of bringing down the premiums while aiming to keep out-of-pocket expenses to a bare minimum. For example, policies provided by Health Management Organization (HMO) requires the patient to visit their primary physician and insurance coverage is provided on a group basis.
There is also the Preferred Provider Organization (PPO) plan, wherein the patient can get lower co-pays if they get treatment from any medical health providers empaneled with a particular insurance company. Within the PPO plan, the patient can also choose Flexible Spending Account (FSA), a sort of payment plan which the doctors themselves offer.
Besides, there is also a Health Savings Account (HAS), which is a medical fund account that needs a substantial upfront contribution to become eligible. For retirees, insurance companies offer Health Reimbursement Arrangement (HRA) for co-pays and deductibles.
An important thing to keep in mind regarding the insurance plans provided by provider networks is that if one were to go outside the “network” providers, then the amount of co-pay would end up being substantially higher and in some cases, the patient might have to foot the entire bill from his pocket.
Private Providers
Besides the two providers mentioned above, several private insurance companies offer coverage for CPAP treatments. Some of these companies include Anthem, Aetna, Cigna, Blue Cross/Blue Shield, United Health Care and Humana. Though these insurance providers are private, they offer coverage at reasonable premiums.
Insurance Codes for CPAP Machine, Masks & Supplies
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 Oral interface used with positive airway pressure (CPAP/BiPAP/APAP) 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 A7046 Water chamber for humidifier, used with positive airway pressure device for positive airway pressure devices 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
O2 Concentrators & Supplies Insurance (HCPCS) Codes
E1356 Oxygen accessory, Battery pack E1357 Oxygen accessory, Battery charger E1358 Oxygen accessory, DC Power Adapter E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1392 Portable oxygen concentrator E0445 Oximeter device for measuring blood oxygen levels non-invasively A4615 Oxygen nasal cannula A4616 Oxygen supply tubing Bottom Line
While insurance plans, in general, provide succor to patients, when it relates to sleep apnea, coverage would mean the difference between waking up tired and exhausted with unrefreshed sleep and having a comfortable and blissful sleep which can keep any diseases that tend to tag along with sleep apnea, at bay. Sleep apnea, in itself, is not dangerous, but other related symptoms can result in it becoming fatal. Hence, it is vital for a sleep apnea patient to get a proper insurance coverage that offers excellent benefits while undergoing CPAP treatment.
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