Medicare Resupply Guidelines
Unless otherwise specified by payer policy, the following Medicare replacement guidelines apply:
**Initial setup is given with a 3 month supply of accessories.**
Every 3 Months
(Qty: 6), A7038, Disposable Filters
(Qty: 1), A7037, Standard Tubing
OR
(Qty: 1), A4604, Heated Tubing
(Qty: 1), A7027, Oral/Nasal Combo Mask
OR
(Qty: 1), A7030, Full Face Mask
OR
(Qty: 1), A7034, Nasal Mask or Nasal Pillows
(Qty: 3), A7031, Full Face Cushion Insert
OR
(Qty: 6), A7033, Nasal Pillow Cushion Insert
OR
(Qty: 6), A7032, Nasal Mask Cushion Insert
OR
(Qty: 6), A7029, Nasal Pillows (for A7027/Combo Mask only)
(Qty: 6), A7028, Oral Cushion (for A7027/Combo Mask only)
Replacement prior to these intervals requires documented justification.
Medi-Cal Resupply Guidelines
MONTHLY
DISPOSABLE FILTERS, A7038 - (2 per month)
NASAL MASK CUSHION, A7032 - (1 per month)
NASAL PILLOW CUSHION, A7033 - (2 pairs per month)
ORAL CUSHION, A7028 - (1 per month)
EVERY 6 MONTHS
ENTIRE NASAL MASK (includes nasal pillow mask), A7034
TUBING, A7037
W/ HEATED COMPONENT, A4604
HEADGEAR, A7035
CHINSTRAP, A7036
NON-DISPOSABLE FILTERS, A7039
HUMIDIFIER CHAMBER, A7046
EVERY 12 MONTHS
ENTIRE FULL FACE MASK, A7030