Comparative Billing Reports

CBR201401: Positive Airway Pressure (PAP) Devices and Accessories

eGlobalTech (eGT) and Palmetto GBA developed and disseminated a national supplier Comparative Billing Report (CBR) on the policy group related to Positive Airway Pressure (PAP) devices and accessories on January 15, 2014. Each CBR contains data-driven tables and graphs with an explanation of findings that compare suppliers’ billing and payment patterns to those of their peers in the state and across the nation for the related PAP Healthcare Common Procedure Coding System (HCPCS) billing codes.

 

CBR201401 analysis for PAP includes the following codes: A7038 (filter, disposable), A7039 (filter, non-disposable), E0561 (humidifier, non-heated), E0562 (humidifier, heated), A7027 (combination oral/nasal mask), A7030 (full face mask), A7034 (nasal interface), A7028 (replacement oral cushion for combo mask), A7029 (replacement nasal pillows for combo mask), A7031 (replacement facemask interface), A7032 (replacement nasal cushion for mask), A7033 (replacement nasal pillows for cannula), A7035 (headgear), A7036 (chinstrap), A7044 (oral interface), A7045 (replacement exhalation port), A7046 (replacement water chamber), E0470 (RAD without back-up rate feature), E0471 (RAD with back-up rate feature), E0601 (continuous positive airway pressure device), A4604 (tubing with heating element), and A7037(tubing without heating element). The following link leads to a document that contains a table of these PAP HCPCS codes: CBR201401 Billing Codes

 

The report references National Coverage Determination (NCD) Policy 240.4, and specifically covers the following Local Coverage Determinations (LCDs) and Policy Articles: L11518, L27230, L11528, L171, A20195, A47228, A19815, A19827, L5023, L27228, L11504, L11493, A23974, A47231, A23659, A23902, A48136, and A9. The following link leads to a document that contains a table of these PAP LCDs and Policy Articles: CBR201401 Policy References