e0601 cpap hcpcs code

Discussion in 'Sleep Apnea & CPAP Users Forum' started by mjervey, Sep 13, 2018.

  1. mjervey

    mjervey New Member

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    I recently got a new health insurance, and I was hoping to get a travel machine under the insurance. When I called up the insurance company, they told me the more modern devices and backup machines are not covered, and I would be allowed a new machine once in three years only under some HCPCS code E0601. Does anyone have an idea about this code and would I be given coverage for “brick” only? If that’s the case, then I am willing to shell out some money and get the travel machine online, since my previous experience with basic “brick,” was not pleasant, to say the least.

    Thanks
     
  2. BadgerSquadron3

    BadgerSquadron3 New Member

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    HCPCS is an acronym for HCFA Common Procedure Coding System. It is a form of medical billing process used by CMS (Centers for Medicare and Medicaid Services). HCPCS was developed for providing a standardized coding system for describing specific items as well as services which is provided in the delivery of healthcare. This coding process is mandatory for Medicaid, Medicare as well as all other health insurance programs existing in the country. The code e0601 deals with CPAP devices. It is not restricted to just “bricks,” but also covers APAP and CPAP machines that have full data ability.

    Sorry to inform but your insurance would not offer coverage for a second machine, not even a brick, for three years. So my suggestion is better to go for a second device online. You can get the detailed description of code e0601 in this link:

    https://www.hipaaspace.com/Medical_Billing/Coding/Healthcare.Common.Procedure.Coding.System/E0601

    One can find a general list of codes related to CPAP here.
     
  3. Kopparberg

    Kopparberg New Member

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    The main reason why your insurance would not cover your machine is that they get one amount for the machine, whether you opt for the fanciest of the machine or just a simple machine. A simple CPAP brick would help then earn good profits compared to the most advanced APAP. To force your insurer to pay for the coverage, you can get your prescribing doctor to write

    “ XYZ Auto Machine with a humidifier and heated hose, and with patient access to AHI and leak data, set at xxx – xxx cm. Dispense as written.”

    Setting a range would enable you to forestall any arguments made by the DME on whether APAP is necessary for you or not. An APAP could be used as an APAP or a simple CPAP machine, but CPAP does not offer you that choice. Dispense as written would compel the DME to give the device as described and they cannot ignore the script.
     
  4. eloquence8

    eloquence8 New Member

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    As @BadgerSquadron3 mentioned, it is better if you go online for purchasing a second machine. If you need it for work, you might be able to get some tax benefits ( I am not sure of the exact benefits, maybe a tax consultant can help). There are many sites which give good machines (used ones) at cheaper rates. You can check those out.
     
  5. LuckyPupil

    LuckyPupil New Member

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    Replying a bit late but further to what @Kopparberg is saying, I would ask you to check with the insurance company as to whether you need to approach the authorized DME or can go to one of your choices. Once you have that clarity, you can call around and see which DME can fill your prescription. You can ignore those DME who would argue with you with regards to the machine.

    Sometimes they might agree to it but would only have one brand. At this time, you have to make a choice, and though they might order the machine of your choice, they would not get any significant benefit from a single device, so would look for ways to avoid ordering. SO be firm and be clear on what options you have.
     
  6. cg303

    cg303 New Member

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    Well, I would only say that at the end of the day, you have to use the machine and not the DME, so do not allow them to browbeat you. It is not so essential for them but could be a matter of life and death for you.

    Anyways Happy Halloween and happy shopping.
     

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