Insurance & Billing
Insurance & Billing
Billing Your Health Insurance Company for Out-of-Pocket CPAP Purchases
Many customers wish to submit a health insurance claim for supplies bought through CPAP Warehouse. To ensure patients use their insurance to the fullest extent, we have included this page of instructions for filing an insurance claim.
Note: CPAP Warehouse can only provide general instructions for our patients. We cannot determine the policies and procedures for each insurance company and thus cannot guarantee that this information is accurate for your specific policy. Please verify the following information with your insurance company before filing a claim.
- Contact the member 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 through CPAP Warehouse).
- Ask your representative which form is necessary to submit the claim information. Some companies will allow you to use the Health Insurance Claim Form. (Link to CMS1500 Claim form)
- 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 numbers).
- Attach a copy of your invoice from CPAP Supplies Plus/Direct. Supplies ordered on your invoice will need to be split into the appropriate HCPCS billing codes based on your purchases.
Example: Our CPAP masks usually come with headgear. Insurance companies process the cost of the 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 price you paid, while the headgear is 30% of the total price. Using this information will allow you to split these costs into the correct codes for your insurance company.
- Submit the claim form and invoice to your insurance company in the method they prescribe (most require you mail; some will allow you to fax).
- Wait for reimbursement. Usually, insurance companies say they can complete claims within 30 business days. Check with your company for their specific turnaround time.
HCPCS Billing Codes
The following HCPCS codes are used by insurance companies to process claims. Codes should correspond to each separate item on your invoice.
Note: Items such as CPAP bed pillows, batteries, and DC adapters are not covered as they are considered luxury products.
|E0601 - CPAP machine purchase||A7038 - CPAP disposable filter||E0470 - BiPAP purchase|
|E0601 - CPAP machine purchase||A7039 - CPAP foam filter||E0471 - BiPAP-ST purchase|
|A7034 - CPAP nasal mask||A7035 - CPAP headgear||A4604 - Thermo Smart Tube|
|A7032 - CPAP nasal mask cushion||A7035 - CPAP headgear||K0553 - Oral/Nasal (Hybrid) Mask|
|A7030 - CPAP Full Face mask||A7033 - CPAP nasal pillows||K0554 - Oral Cushion for Hybrid Mask|
|A7031 - CPAP Full Face mask cushion||A7036 - CPAP chinstrap||K0555 - Nasal Cushion for Hybrid Mask|
|A7044 - CPAP Full Oral Interface||E0561 - CPAP Passover Humidifier||E1399 - CPAP Miscellaneous (to be used for any CPAP items covered by your insurance but not listed above.)|
|A7037 - CPAP tubing, long and short hoses||E0562 - CPAP Heated Humidifier|