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
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 purchase
E0471 - BiPAP-ST 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 to 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 Information
Your insurance company might require information regarding CPAP Warehouse to process your claim so please feel free to reach out to us for any information that may be required.