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What Are HCPCS Codes For CPAP?

Jan 16, 2023

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Every medical supply or management services has an associated billing code or HCPCS code. HCPCS (Healthcare Common Procedure Coding System), which is essentially the same as CPT (Current Procedural Terminology) codes, are used by government healthcare providers. “billing codes” are often used to describe the CPT or HCPCS codes.

Health insurers in the US handle more than 5 billion claims for payment each year. Standardized coding methods are necessary for Medicare and other health insurance plans to guarantee that these claims are handled orderly and uniformly. One of the standard code sets is the HCPCS Code Set.

Discover below the specific HCPCS codes we created for the goods and services provided in health care delivery.

HCPCS Reference Codes For CPAP And Respiratory Equipment

HCPCS reference codes serve to identify medical services and supplies for billing. The usage of CPAP (Continuous Positive Airway Pressure) and respiratory-related equipment is associated with unique codes known as HCPCS reference codes for CPAP and respiratory equipment. These codes are used to charge for the CPAP for obstructive sleep apnea and other sleep disorders and respiratory treatment-related equipment, services, and supplies.

When filing claims to insurance companies for payment of services and supplies associated with the use of these therapies, medical professionals utilize them. For timely and correct invoicing of services and supplies related to CPAP and respiratory treatments, HCPCS reference codes for CPAP and respiratory equipment are required.

HCPCS Codes For BiPAP/CPAP Machine Coverage

Below is the list of HCPCS codes For BiPAP/ CPAP Machine Coverage

HCPCS CODE: E0601

Equipment for continuous airway pressure (APAP/CPAP)

HCPCS CODE: E0470

Bi-level positive airway pressure (BiPAP) capable respiratory assist device, without backup rate feature, utilized with a non-invasive interface, such as a nasal or facial mask (intermittent assist device with continuous positive airway pressure (CPAP) device)

HCPCS CODE: E0471

Intermittent support equipment with continuous positive airway pressure devices, respiratory assist device with bi-level positive airway pressure (BiPAP) capacity, WITH backup rate function, utilized with a noninvasive interface, such as a nasal or facial mask

HCPCS CODE: E0472

When utilized with an invasive interface, such as a tracheostomy tube, a respiratory aid device with bi-level positive airway pressure (BiPAP) capabilities, WITH a backup rate function, is employed.

HCPCS CODE: E0561

When used with positive airway pressure (CPAP, BiPAP, APAP) equipment, a non-heated humidifier

HCPCS CODE: E0562

A heated humidifier is employed with positive airway pressure (BiPAP, APAP, CPAP) equipment.

HCPCS Codes For BiPAP/CPAP Mask Coverage 

Below are the list of HCPCS codes For BiPAP/ CPAP Mask Coverage 

HCPCS CODE: A7030

Positive Airway Pressure (BiPAP, APAP, CPAP) equipment with a Full Face Mask

HCPCS CODE: A7034

With or without a head strap, a nasal interface (mask or cannula type) is used with positive airway pressure (CPAP/BiPAP/APAP) equipment.

HCPCS CODE: A7044

Oral interface for positive airway pressure (CPAP, BiPAP, APAP) equipment

HCPCS CODE: A7027

Combining oral/nasal mask used in conjunction with continuous positive airway pressure device.

Part & Accessory Insurance For BiPAP/CPAP (HCPCS) Codes

Below is the list of HCPCS codes For BiPAP/CPAP (HCPCS) Codes 

HCPCS CODE: A7028

Oral Cushion Replacement for Oral/Nasal Mask Combination

HCPCS CODE: A7029

Nasal Pillow Cushion Replacement for Oral and Nasal Mask

HCPCS CODE: A7031

An additional cushion for a full-face mask

HCPCS CODE: A7032

Nasal mask cushion replacement

HCPCS CODE: A7033

Replacement Pillows for Cannula Style Mask or Nasal Pillows

HCPCS CODE: A7035

Headgear used with a positive pressure ventilation system

HCPCS CODE: A7036

Chinstraps work in tandem with positive airway pressure apparatus.

HCPCS CODE: A7037

Tubing used in conjunction with a positive airway pressure equipment

HCPCS CODE: A4604

With a positive airway pressure device, heated tubing is utilized.

HCPCS CODE: A7038

Disposable filter used in conjunction with a positive airway pressure equipment

HCPCS CODE: A7039

Filter used in conjunction with a positive airway pressure device that is not disposable

HCPCS CODE: A7045

Positive airway pressure device attachments may include an exhalation port with or without a swivel.

HCPCS CODE: A7046

Use of a humidifier’s water chamber with a positive pressure ventilation system

HCPCS CODE: E1399

Items, Components, and Accessories of Various Durable Medical Equipment

HCPCS Codes For Nebulizer And Compressor Coverage

Below is the list of HCPCS codes For Nebulizer And Compressor Coverage

HCPCS CODE: E0570

Combined compressor and nebulizer

HCPCS CODE: A7005

Non-disposable administration equipment with a small capacity, nonfiltered pneumatic nebulizer

HCPCS CODE: A7004

Disposable small-volume nonfiltered pneumatic nebulizer

HCPCS CODE: A7003

Disposable administration set with a small-volume, nonfiltered pneumatic nebulizer

HCPCS CODE: A7015

Using an aerosol mask with a DME nebulizer

HCPCS CODE: A7014

Non-disposable filter used with an ultrasonic generator or an aerosol compressor

HCPCS CODE: A7013

Disposable filter for use with an ultrasonic generator or an aerosol compressor

HCPCS CODE: A4627

Chamber for use with metered dose inhaler, with or without a mask

HCPCS Codes For Light Therapy Equipment Coverage

Below is the list of HCPCS code For Light Therapy Equipment Coverage

HCPCS CODE: E0203

Device for light treatment

HCPCS Codes For Oxygen Concentrators & Supplies Coverage

Below is the list of HCPCS codes For Oxygen Concentrators & Supplies Coverage

HCPCS CODE: E1356

Battery pack and an oxygen attachment

HCPCS CODE: E1357

Accessory for oxygenation, battery charger

HCPCS CODE: E1358

Accessory for oxygen, DC power adapter

HCPCS CODE: E1390

Single-port oxygen concentrators can supply 85 percent or greater oxygen concentration at the specified flow rate.

HCPCS CODE: E1392

Oxygen concentrator that is accessible

HCPCS CODE: E0445

Oximeter for non-invasively monitoring blood oxygen levels

HCPCS CODE: A4615

Nasal Oxygen Cannula

HCPCS CODE: A4616

Supply tubes for oxygen

These codes are solely for reference; you should confirm their correctness with your insurer. Rules and processes for filing successful claims vary across insurers. Please get in touch with your healthcare provider to determine the steps you need to take to make a successful claim. Visit the Centers for Medicare & Medicaid Services to learn more about HCPCS codes. If you want to learn about ICD codes, you can visit the World Health Organization.

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Insurance Codes

CPAP Network  does not bill any insurance, Medicare or Medicaid. We are a free-market provider which allows us to offer the most cost-effective options to people with high deductibles. If you have a high deductible health plan, you are basically self-insured until your deductible is met. This is where smart out-of-pocket purchasing can be the most economical and hassle-free.  

If you choose to submit an insurance claim form for reimbursement, CPAP Network will assist by providing a detailed purchase order with all the required data. Below are the HCPCS codes you may need for the claim form:

HCPCS CODES

CPAP/BiPAP MACHINE 

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

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 PARTS & ACCESSORIES

A7028  - Oral cushion for combination oral/nasal mask

A7029  - Nasal pillows for combination oral/nasal mask

A7031  - Replacement Cushion for Full Face Mask

A7032  - Replacement Cushion for Nasal Mask

A7033  - Replacement Pillows for Nasal 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

( CPT  is a code set to describe medical, surgical ,and diagnostic services;  HCPCS  are codes based on the CPT to provide standardized coding when healthcare is delivered) 

OTHER INFO: 

Provider Diagnosis Code

Diagnosis code for Obstructive Sleep Apnea is G47.33 (contact your provider for your specific diagnosis code) Our Company Information Most frequently requested information: CPAP Network LLC 1437 Egg Harbor Road Sturgeon Bay, WI  54235 Phone: 888.293.4811 Fax: 920.367.0533 Tax ID Number: 82-5030164

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Sleep Medicine Codes

International classification of disease (icd-10 – clinical modification ( cm)) diagnostic coding system.

The 10th revision of the International Classification of Diseases and related health problems (ICD-10-CM) is a uniform diagnostic coding system.  Maintenance of ICD-10-CM is the responsibility of the CDC’s National Center for Health Statistics (NCHS) under authorization by the World Health Organization (WHO). In practice, ICD-10-CM has become the international standard diagnostic classification for all general epidemiological and many health-management purposes that translates diagnoses into a seven-character, alphanumeric code, which permits easy storage, retrieval, and analysis of the data. ICD-10-CM classifies diagnoses and reasons for visits in all health care settings, and is primarily used to categorize, and describe general types of injuries and diseases, and identify medical diagnoses furnished by physicians and other health care professionals. Visit the AASM Store to access the most current version of the authoritative clinical text for the diagnosis and treatment of sleep disorders, the International Classification of Sleep Disorders.

Current Procedural Terminology (CPT®) Codes

The CPT code set is a uniform coding system consisting of descriptive terms and identifying codes (5 numeric digits) that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. The CPT code set is maintained by the American Medical Association (AMA) and decisions regarding addition, deletion or revision of CPT codes are made by the CPT Editorial Panel. Although not all-inclusive, the below tables list some of the more frequently used codes in sleep medicine.

Sleep Services Codes

Note: Use the Technical Component (TC) modifier when only the technical component is billed and the 26 (professional component) modifier when only the professional component is billed.

Evaluation and Management (E/M Codes)

Sleep physicians also use Evaluation and Management codes to bill for office visits. Assigning codes for office visits can be complex, however, Medicare has an Evaluation and Management Services guide you can refer to for more information.

Evaluation and management codes are restricted to physicians and other qualified advanced nurse practitioners (NPs, PAs, etc.). Technologists cannot bill independently but they can bill incident to the physician (if certain guidelines are followed).

Find more information about the E/M Code Changes, here .

E/M Add-on Code

Healthcare common procedural coding system (hcpcs).

HCPCS is divided into two subsystems: Level I (comprised of the CPT code set) and Level II. Level II of the HCPCS is a standardized coding system (a single alphabetical letter followed by 4 numeric digits) that is primarily used to identify products, supplies and services not included in the CPT code set. HCPCS Level II codes include ambulance services and durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) when used outside a physician’s office.

G Codes (home sleep apnea testing)

The G codes (G0398, G0399 and G0400), which describe home sleep apnea testing (HSAT) services, were added to the Healthcare Common Procedure Coding System (HCPCS) Level II in 2008. Some insurers accept the G codes while others accept the CPT® codes for HSATs (95800, 95801 and 95806). An HSAT provider will need to contact each insurer they work with to identify which codes can be reported.

Durable Medical Equipment (DME) Sleep Medicine Codes

All E codes fall under the jurisdiction of the DME MAC unless otherwise noted.

Psychology/Psychiatry Codes

Note: CPT Copyright 2021 American Medical Association.  All rights reserved. CPT® is a registered trademark of the American Medical Association.

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Common hcpcs codes for sleep therapy and oxygen equipment & supplies

Although Sleep Restfully, Inc does not file claims with your insurance company for reimbursement many insurance companies will consider claims filed directly by the insured party.  These claims must contain the appropriate HCPCS code in order to be considered.  In an effort to assist out customers in filing a claim we are providing a list of the most common HCPCS codes used for sleep therapy and oxygen therapy equipment and supplies.

CPAP/BiLevel Michine HCPCS Codes:

E0601 Continuous airway pressure device (CPAP/APAP)

E0470 Respiratory assist device, bi-level pressure 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 capability, with back-up 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 capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)

E0571 Humidifier, non-heated, used with positive airway pressure device

E0562 Humidifier, heated, used with positive airway pressure device

CPAP/Bi-Level Mask HCPCS Codes

A7030 Full face mask used with positive airway pressure device, each

A7034 Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap

A7044 Oral interface used with positive airway pressure device

A7027 Combination oral/nasal mask, used with continuous positive airway pressure device, each

CPAP & Bi-Level Parts and Accessories

A4604 Heated Tube used with Positive airway pressure device

A7028 Oral cushion for combination oral/nasal mask, replacement only, each

A7029 Nasal pillows for combination oral/nasal mask, replacement only, pair

A7031 Face mask interface, replacement for full face mask, each

A7032 Cushion for use on nasal mask interface, replacement only, each

A7033 Pillow for use on nasal cannula type interface, replacement only, pair

A7035 Headgear used with positive airway pressure device

A7036 Chinstrap used with positive airway pressure device

A7037 Tubing used with positive airway pressure device

A7038 Filter, disposable, used with positive airway pressure device

A7039 Filter, non disposable, used with positive airway pressure device

A7045 Exhalation port with or without swivel used with accessories for positive airway devices, replacement only

A7046 Water chamber for humidifier, used with positive airway pressure device, replacement, each

Oxygen Concentrators & Supplies

A4615 Oxygen Nasal Cannula

A4616 Oxygen Supply Tubing

E0445 Oximeter device for measuring blood oxygen levels non-invasively

E1356 Oxygen accessory, battery pack/cartridge for portable concentrator, any type, replacement only, each

E1357 Oxygen accessory, battery charger for portable concentrator, any type, replacement only, each

E1358 Oxygen accessory, dc power adapter for portable concentrator, any type, replacement only, each

E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate

E1392 Portable oxygen concentrator

Miscellaneous Medical Equipment

E1399 Durable medical equipment, miscellaneous

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AirMini AutoSet Travel Auto-CPAP Machine Package

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One of the smallest CPAPs in the world is also one of the most advanced. AirMini brings ResMed's proven AutoSet Auto-CPAP algorithms, industry leading EPR comfort technologies, and unmatched design and quality to a truly portable Auto-CPAP. It's quiet and small and weighs just 10.6 ounces!

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Small & Portable: Great for Home & Travel:  Resmed's AirMini is more than just an ultra portable Auto-CPAP machine, it's a turn-key solution for sleep therapy at home or on the go. AirMini Auto includes ResMed's advanced Autoset and AutoSet For Her breathing algorithms that provide effective therapy at the lowest pressure levels all night long. The AutoSet algorithm monitors your breathing and, when it detects flow limitations, it gently increases pressure until the event has cleared. After an event AutoSet decreases pressure again to improve overall sleep comfort.

HumidX Effective Waterless Humidification: Leave your distilled water at home and still get the benefits of humidification! AirMini’s HumidX & HumidX Plus Heat Moisture Exchanging (HME) Humidifying Filters provide the comfort of humidification without the bulk hassle of your typical water based humidifier systems. The HumidX Humidifying Filters work by capturing the moisture from exhaled heat and stores it in the HME prior to reaching your masks vents. When you inhale the HumidX HME releases the humidity back into your therapy stream for portable, waterless and effective humidification.

• HumidX HME Humidifiers are exclusively compatible with the following AirMini Mask Setup Packs: AirFit and AirTouch N20 & N30 Nasal, F20 Full Face, and P10 Nasal Pillow.
• HumidX: Use standard HumidX HMEs for most climates and sleep environments.
• HumidX Plus: Use HumidX Plus for dry and high altitude environments, like aircraft, where humidity is low.

Enhanced Compliance with Bluetooth & the AirMini App: Manage your sleep therapy and comfort settings with ease when you download the free AirMini App for iOS and Android. You can also track your therapy progress directly on your phone or tablet! With a simple push of a button the sophisticated AirMini App syncs data wirelessly, via a Bluetooth connection, so you can review your score each morning as well as access the previous 30 days of sleep data too. Using the AirMini App is a great way to stay on top of your sleep therapy!

SmartStart & Auto Stop Convenience: The AirMini’s SmartStart function starts your sleep apnea therapy as soon as you breathe into your mask. If you remove your mask, the therapy will stop after just a few seconds. You also have the option to stop your therapy on your own if you prefer, AirMini lets you do that with just a touch of a button.

Expiratory Pressure Relief: ResMed's Expiratory Pressure Relief feature will reduce the work of breathing during exhalation and provide a gentle pressure that naturally adapts to your breathing cycle throughout the night. You can turn off the Expiratory Pressure Relief or choose levels from 1 to 3, 1 being the minimum pressure relief and 3 being the maximum.

AutoRamp with Sleep Onset Detection: AirMini’s AutoRamp feature with sleep onset detection helps make your sleep therapy comfortable from the moment you turn on your device. The AutoRamp feature works by delivering a lower pressure setting to help you fall asleep easier. Once the device detects that you’re asleep, it comfortable ramps up the pressure to ensure the device is delivering your prescribed pressure setting. If you prefer a set ramp time or want the auto ramp turned off all together, you can simply do that too. Comfort settings are easy with the AirMini App!

FAA Approved for Use on Commercial Flights: The AirMini is great for home, but it is FAA approved and built for travel as well. You can slide it into your overnight bag and head out the door, or better yet upgrade with a custom fit AirMini Premium Travel Bag for added protection and convenience.

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