RETIRED - Positive Airway Pressure Device and Respiratory Assist Device - Nasal Interfaces and Liners - Revised

IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.

Originally Published June 2005
Updated July 10, 2014

There are two types of nasal interfaces that are used with a Positive Airway Pressure (PAP) device or a Respiratory Assist Device (RAD) - a nasal mask and cannula-type interface.

Both of these types of products are coded A7034 (NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HEAD STRAP). HCPC Code A7034 includes the soft interface at initial issue.

HCPCS codes A7032 (CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH) and A7033 (PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY, PAIR) describe replacement soft interfaces. HCPCS code A7032 is used for a nasal mask interface that goes around the nose, but not into the nostrils. The unit of service for this HCPCS code is "each." HCPCS code A7033 is used for a nasal cannula-type interface. This interface extends a short distance into the nostrils. The unit of service for this code is "pair." For some products, there are two physically separate cushions or "pillows" - one for each nostril. Two cushions/pillows (i.e. "pair") equals one unit of service of HCPCS code A7033. For other products, the interface is a single piece with two protrusions that extend into the nostrils. One of these interfaces equals one unit of service of HCPCS code A7033.

Liners are not interfaces for use with a PAP mask. Liners are products placed between the patient's skin and the PAP mask interface and are made of cloth, silicone or other materials. These are not considered "interfaces" as defined in the PAP Local Coverage Determination (LCD) and related Policy Article, and as described above. Liners must not be billed as replacement interface for a PAP mask using codes such as A7031 (Face mask interface, replacement for full face mask, each) or A7032 (Cushion for use on nasal mask interface, replacement only, each).

A liner used in conjunction with a PAP mask is considered a comfort and convenience item and must be coded A9270 (Noncovered item or service). There is no additional payment for liners used with a PAP mask (see Medicare Benefit Policy Manual 100-2 Chapter 15 Section 110.1).

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 Form located on the PDAC website: https://www.dmepdac.com/.

 

Last Updated Thu, 10 Jan 2019 13:04:46 +0000