Tips for Billing Positive Airway Pressure (PAP)/Respiratory Assist Device (RAD) Accessories

The Standard Written Order (SWO) for the device and/or accessories may be completed by someone other than the treating practitioner. The SWO may then be sent to the treating practitioner to review and sign prior to claim submission.

Accessories for use with medically necessary beneficiary-owned equipment may be billed with the KX modifier if the criteria outlined in the Local Coverage Determination (LCD) have been met.

A narrative must be included for supplies used with beneficiary-owned equipment. The narrative must include:

  • HCPCS of base equipment
  • Indication that equipment is beneficiary-owned
  • Approximate month and year of purchase

Narrative example for accessories with beneficiary-owned equipment:

  • Bene-owned E0601 pur Jan 2023 (approximate)

Multiple accessories that provide the same function will not be payable on the same date of service (DOS) or within the usual maximum timeframe specified in the LCD. Examples include but are not limited to:

  • HCPCS A7037 (tubing) and A4604 (heated tubing)
  • Multiple masks (A7027, A7030, and A7034)

Same or similar equipment on file may be verified through the Noridian Medicare Portal.

  • For more information on Noridian Medicare Portal registration: Registration Guide
  • Existing users may use the Portal Guide for more information: Inquiry Guide
Last Updated Apr 03 , 2024