What is CPAP ?

What does CPAP stand for?

CPAP is the acronym for Continuous Positive Airway Pressure. CPAP therapy provides a constant flow of air at a set pressure into the airway to ensure that the airway stays open through the night.It is a treatment that uses mild air pressure to keep the airways open. CPAP typically is used by people who have breathing problems, such as sleep apnea etc.

CPAP also may be used to treat preterm infants whose lungs have not fully developed. For example, doctors may use CPAP to treat infants who have respiratory distress syndrome orbronchopulmonary dysplasia (brong-ko-PULL-mun-ary dis-PLA-ze-ah). For this treatment, soft prongs are placed in an infant’s nostrils. The CPAP machine gently blows air into the baby's nose, which helps inflate his or her lungs.

The main focus of this article is CPAP treatment for sleep apnea, although treatment in preterm infants is discussed briefly.

Overview

CPAP treatment involves a CPAP machine, which has three main parts:

• A mask or other device that fits over your nose or your nose and mouth. Straps keep the mask in place while you're wearing it.
• A tube that connects the mask to the machine's motor.
• A motor that blows air into the tube.

Some, CPAP machines have other features as well, such as heated humidifiers. CPAP machines are small, lightweight, and fairly quiet. The noise that they make is soft and rhythmic.

                             

CPAP often is the best treatment for obstructive sleep apnea. Sleep apnea is a common disorder that causes pauses in breathing or shallow breaths while you sleep. As a result, not enough air reaches your lungs.

                           

In obstructive sleep apnea, your airway collapses or is blocked during sleep. When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Your snoring may wake other people in the house.The mild pressure from CPAP can prevent your airway from collapsing or becoming blocked.

If your doctor prescribes CPAP, you’ll work with someone from a home equipment provider to select a CPAP machine. (Home equipment providers sometimes are called durable medical equipment, or DME.)

Your doctor will work with you to make sure the settings that he or she prescribes for your CPAP machine are correct. He or she may recommend an overnight sleep study to find the correct settings for you. Your doctor will want to make sure the air pressure from the machine is just enough to keep your airway open while you sleep.

There are many kinds of CPAP machines and masks. Let your doctor know if you're not happy with the type you're using. He or she may suggest switching to a different type that might work better for you.

Outlook

CPAP has many benefits. It can:

• Keep your airway open while you sleep.
• Correct snoring so others in your household can sleep.
• Improve your quality of sleep.
• Relieve sleep apnea symptoms, such as excessive daytime sleepiness.
• Decrease or prevent high blood pressure.

Many people who use CPAP report feeling better once they begin treatment. They feel more attentive and better able to work during the day. They also report fewer complaints from bed partners about snoring and sleep disruption.

In some preterm infants whose lungs have not fully developed, CPAP improves survival. It also can reduce the need for steroid treatment for the lungs.

Also, in some infants, CPAP prevents the need to insert a breathing tube through the mouth and into the windpipe to deliver air from a ventilator. (A ventilator is a machine that supports breathing.)

CPAP treatment is less invasive than ventilator therapy. Research suggests that CPAP is an appropriate first treatment for some preterm newborns.

How to Bill Your Health Insurance for Your Out-of-Pocket CPAP Expenses

Many of our Patients / Customers have requested us in reference of submitting a Health Insurance Claim for the Machine and Supplies bought through PRIMO MEDICAL SUPPLIES. To help our Customers / Patients to use their insurance to their fullest benefit, we have decided to include this page of general instructions for filing an insurance claim on your own behalf for CPAP and BIPAP supplies. 

Please Note: Medicare does not allow patients to submit claims on their own behalf. These claims must be billed from a Medical Equipment Company with a Medicare Provider Number.

Please Note: PRIMO MEDICAL SUPPLIES  can only provide general instructions for our patients. We cannot determine the policies and procedures for each insurance company and therefore cannot guarantee that this information is accurate for your specific policy. Please verify the following information with your company prior to filing a claim.

General Instructions :-

1. Contact the Customer Service or Members Services department of your insurance company directly to ensure that they allow subscribers to submit claims for medical expenses purchased out-of-pocket (such as the CPAP supplies you purchased throughPRIMO MEDICAL SUPPLIES).
2. When speaking with the representative from your insurance, ask them on what type of form they require you to submit your claim information. Some companies will allow you to use a generic document called the Health Insurance Claim Form. You can download the form by clicking this link here or can copy paste the URL provided:                                                                                                                                                     http://www.usrds.org/forms/08_1500_Health_Insurance_Claim.pdf                              Copy of Health Insurance Claim Form              
3. Complete the form required, including the billing and qualifying information used by insurance companies to process claims (See below: HCPCS codes, Diagnosis Codes, and Tax ID number).
4. Attach a copy of your invoice from PRIMO MEDICAL SUPPLIES. Supplies ordered on your invoice will need to be split into the appropriate HCPCS billing codes based on your purchases.Example: Our CPAP Masks generally come with a headgear(If you are Purchasing the Mask). Insurance companies process the cost of mask headgear and the mask separately. When you send your invoice you will need to make these separations. As a general rule, the cost of your mask alone is 70% of the total cost you paid, while the headgear is 30% of the total cost. Using this general rule will allow you to split these costs into the correct codes for your insurance company.
5. Submit the claim form and invoice to your insurance company in the method they prescribe (most require you to mail; some will allow you to fax along with the Sleep Study Report and Prescription from your Doctor).
6. Wait for reimbursement. Generally, insurance companies say they can complete claims within 30 business days. Check with your company for their specific turnaround time.
7. Required Billing Codes are provided below:

HCPCS Billing Codes:

The following HCPCS codes are used by insurance companies to process claims. Please use the appropriate code on your claim form to ensure timely processing. Codes should correspond to each separate item on your invoice. 

Please Note: Items such as CPAP Wipes, SO Clean 2, CPAP Bed Pillows, Batteries, and DC adapters are not covered as they are 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 Machine purchase 

E0471 - BiPAP-ST Machine purchase 

A4604 - Thermo Smart Tube 

K0553 - Oral/Nasal (Hybrid) Mask 

K0554 - Oral Cushion for Hybrid Mask 

K0555 - Nasal Cushion for Hybrid Mask 

E1399 - CPAP Miscellaneous (this code is to be used for any CPAP items covered by your insurance but not listed above. 

Physician Diagnosis Code :-

Insurance companies require you provide a code associated with your specific Medical Diagnosis. The diagnosis code for Obstructive Sleep Apnea is 327.23. To ensure that you have the correct code for your diagnosis, contact your physician.

Our Company InformationYour insurance company may require information about PRIMO MEDICAL SUPPLIES to process your claim. The most requested information is below:

PRAN MEDICAL LLC

DBA PRIMO MEDICAL SUPPLIES

7515 Grissom Rd Suite 107

San Antonio Texas 78251

Phone: 210-519-5311

Fax: 210-399-3561
Tax ID Number: 46-5629717