Durable Medical Equipment

Created by alyssajuda

Medtronic, CPAP materials

What is the tier and cost of a CPAP machine for a member?
Is the entire cost of the CPAP owed up front?
What is the tier and cost of the Combination oral/nasal mask, used with continuous positive airway pressure device, each?
Is there a copay for A7029, A7032, A7035, A7038? Why or why not?
Are all supplies included when a member first gets a CPAP machine?"
Does a member need a referral to see a provider who can prescribe a CPAP?
How many times can a member pick up A7028 Oral cushion for combination oral/nasal mask, replacement only, each?

Answer Key
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Durable Medical Equipment (Answer Key)

Created by alyssajuda

Medtronic, CPAP materials

What is the tier and cost of a CPAP machine for a member?
Tier 8, $200
Is the entire cost of the CPAP owed up front?
No, rent to own. Payment of $20 a month for ten months, paid to the facility that CPAP is from
What is the tier and cost of the Combination oral/nasal mask, used with continuous positive airway pressure device, each?
Tier 4, $60
Is there a copay for A7029, A7032, A7035, A7038? Why or why not?
No copay, $0. Because they are Tier 1
Are all supplies included when a member first gets a CPAP machine?"
No, each item falls into it's own tier and its billed separately
Does a member need a referral to see a provider who can prescribe a CPAP?
No referral needed to see a provider, but they do need a prescription
How many times can a member pick up A7028 Oral cushion for combination oral/nasal mask, replacement only, each?
As medically necessary and prescribed by provider. At this time, no limit

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