CPAP for one year - CONFUSED

[<Marine>>Mom]

I would like an explanation - please I am begging. I use a Wisp Nasal mask. ResMed. I use the normal head strap, the mask and nothing else. What is the difference between the nasal mask and a "cushion" for the mask? My mask is one piece. I do not attach anything to the mask itself. Can someone explain to me what the cushion is for and how is it used? As far as I can tell I do not use a cushion. I use the nasal mask. My DME (not the sharpest tools in the shed) tried to tell me that the insurance industry requires that 3 codes are used for the mask, the cushion and the headgear. Has anyone else been told that? I understand that 3 separate pieces of equipment (mask, head gear, cushion) would need 3 separate codes. But I do not use a cushion. Is my DME billing me for the wrong equipment? I would appreciate any help or explanation offered.

Marines are not a branch. They are a breed.

[zoocrewphoto]

The soft cushy part comes away from the frame for cleaning and replacement. There are also different sizes to get the right fit.

[kaiasgram]

This page from our forum sponsor's website shows the component parts of the Wisp: https://www.cpap.com/productSearch.php#::::wisp:

[<Marine>>Mom]

So the soft piece that fits over my nose is the cushion? I thought that was the mask. I am concerned that my DME is billing my insurance and me for something I do not use. Can I list the way the DME bills it on the EOB? Is it ok to do that?

[kaiasgram]

So the soft piece that fits over my nose is the cushion? I thought that was the mask. I am concerned that my DME is billing my insurance and me for something I do not use. Can I list the way the DME bills it on the EOB? Is it ok to do that?

Sure!

[<Marine>>Mom]

On my EOB:

Code A7034 nasal mask

Code A7032 mask cushion

Code A7035 headgear

these are the 3 codes my DME says are necessary to file the claim the way the insurance companies want it done. All three of these are considered the mask.

Is this right? They are billing for a nasal mask and a mask cushion. Why would there be two different codes for the same thing? I know I should let it go but not understanding really bugs me. Plus I have found some discrepancies in their billing so now I look at everything.

[<Marine>>Mom]

thank you both for your help. I will check back in the am. I live in the SW so its 1 am.


Gish
You make a mistake if you think one Marine is outnumbered.

[kaiasgram]

Those billing codes are correct. If you look at the link I posted earlier you see that these are the individual parts of the whole mask. And this way of billing is standard practice.

[Tatooed Lady]

Headgear goes around back of head...frame (apparently referred to as "nasal mask") is the plasticky part going from headgear...and cushion is what is in contact with your nose.

[<Marine>>Mom]

Those billing codes are correct. If you look at the link I posted earlier you see that these are the individual parts of the whole mask. And this way of billing is standard practice.

I did look and thank you so much. Thank everyone for their help. I can get this off my mind since I understand;. I am still firing my DME but for the other billing issues.

Thanks to all. This site is a God send.

Gish
God is fond of us all. If God had a refrigerator, our pictures would be on it.

[kaiasgram]

Those billing codes are correct. If you look at the link I posted earlier you see that these are the individual parts of the whole mask. And this way of billing is standard practice.

I did look and thank you so much. Thank everyone for their help. I can get this off my mind since I understand;. I am still firing my DME but for the other billing issues.

Thanks to all. This site is a God send.

You're very welcome -- now, get some sleep.