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February 12, 2015

Non-Invasive Interfaces Used in Conjunction with HCPCS Code E0472 - Correct Billing

Joint DME MAC Publication

Recently during claims review it was noted that suppliers are billing HCPCS code 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)) with non-invasive interfaces.  This is not correct billing. As noted in the code descriptor, code E0472 is reserved for devices used with an invasive interface.  Claims for E0472 must not be billed with any of the following non-invasive interfaces or accessories:

A7027 - COMBINATION ORAL/NASAL MASK, USED WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE, EACH
A7028 - ORAL CUSHION FOR COMBINATION ORAL/NASAL MASK, REPLACEMENT ONLY, EACH
A7029 - NASAL PILLOWS FOR COMBINATION ORAL/NASAL MASK, REPLACEMENT ONLY, PAIR
A7030 - FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH
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
A7034 - NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HEAD STRAP
A7035 - HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE
A7036 - CHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE DEVICE
A7044 - ORAL INTERFACE USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH

Claims for devices used with a non-invasive interface are billed with HCPCS codes E0470 or E0471, depending on whether or not the device has a backup rate feature.

For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact FormExternal PDF.

Reference Information:
Respiratory Assist Devices LCDExternal Website
Respiratory Assist Devices Policy ArticleExternal Website

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