Medicare - BiPaP and ASV machine accounting code EO471

[Mahonetd]

My doctor diagnosed me with Central Sleep Apnea and recommended an ASV machine. Currently using a Phillips BIPAP ST. Upon ordering a ResMed Aircurve 10 ASV, I was informed that Medicare would not pay for the machine because my current machine and the ASV machine have the same accounting code EO471.
My doctor tells me that the machine have entirely different functions. Medicare won't pay. The alternatives are to pay full price of search for a rebuilt ResMed S9 Series machine. He also indicated that Medicare might be holding a review of this issue sometime this Summer. ??
Has anyone experienced this problem and / or found a solution?
Thanks

[Miss Emerita]

I'm afraid I don't have experience with this issue, but I'm curious who exactly told you Medicare would not cover the machine your doctor has prescribed for you? Could you let us know?

[chunkyfrog]

Have your doctor write a letter of medical necessity to Medicare.
A simple prescription may not get the attention of the correct people.

[Mahonetd]

Reply to Miss Emerita: The comment about Medicare came from the supplier / distributor providing the machines to the hospital doctor. They said that when they processed preliminary paperwork to Medicare, the response was that since both machines had the same accounting code EO471, they would not pay for the second machine (ASV). I assume that it was meant to say, we are not buying the same machine twice.
Hope this clarifies the comment

[SleepGeek]

My doctor diagnosed me with Central Sleep Apnea and recommended an ASV machine. Currently using a Phillips BIPAP ST. Upon ordering a ResMed Aircurve 10 ASV, I was informed that Medicare would not pay for the machine because my current machine and the ASV machine have the same accounting code EO471.
My doctor tells me that the machine have entirely different functions. Medicare won't pay. The alternatives are to pay full price of search for a rebuilt ResMed S9 Series machine. He also indicated that Medicare might be holding a review of this issue sometime this Summer. ??
Has anyone experienced this problem and / or found a solution?
Thanks

Are you getting both items from the same place? Same Dr.?

I seem to recall that when I started there is something in the agreement the DME has with Medicare that if changes were needed the DME would have to take the first unit back. You might end up with a used unit but they would have to provide the upgrade.

I would contact Medicare directly to ask those questions. It seems like IF they get you to pay out of pocket they will get FULL price which they wouldn't get with Medicare. One or both may be lying to you.

IF they are I would bring my business elsewhere after filing a complaint with Medicare.

Ex. When I started like most I was started on a straight cpap and I seem to remember if I needed an auto cpap or bipap before the time was up (5yr?) that it would provided at no cost to me. I did and it was. There may be something the doc has to document but if they are playing dumb I wouldn't give them any more business.

[chunkyfrog]

Since Medicare commonly has perpetual rental on this class of machine,
trading the current machine for the Resmed should be possible,
as long as your doctor writes the LETTER OF MEDICAL NECESSITY.
Get that done--stop spinning your wheels.

[Mahonetd]

Thanks for the advice. I will call the doctor and ask him to prepare the certificate of medical necessity. Interesting, since he made believe there was no way to appeal the statement about the same accounting code.
Thanks

[Miss Emerita]

Thanks for the advice. I will call the doctor and ask him to prepare the certificate of medical necessity. Interesting, since he made believe there was no way to appeal the statement about the same accounting code.
Thanks

Excellent. Let us know what happens, would you? That could be helpful for others to know.

[Pugsy]

Why the change to the ResMed?
Is it because of the Philips Respironics recall?
Have you contacted Medicare yourself? If not, you should. Explain why the doc wants to prescribe the ResMed.

[Miss Emerita]

I think the big change is from ST to ASV; does that make sense?

[Mahonetd]

Yes it is a change from ST to ASV. The sleep test said that I needed the ASV therapy. The issue with Medicare is that both machines have the same accounting code EO471.
I am meeting with my doctor on Tuesday to see if he will complete the Certificate of Medical Necessity.
Thanks to everyone for your comments

[ChicagoGranny]

I am meeting with my doctor on Tuesday to see if he will complete the Certificate of Medical Necessity.

Good grief. Could that not be done by digital messaging?

[chunkyfrog]

But if you are in the office, they know you mean business.
Virtual stuff gets blown off.

[SleepGeek]

Yes it is a change from ST to ASV. The sleep test said that I needed the ASV therapy. The issue with Medicare is that both machines have the same accounting code EO471.
I am meeting with my doctor on Tuesday to see if he will complete the Certificate of Medical Necessity.
Thanks to everyone for your comments

You really need to speak directly with Medicare not the people who are trying to steal your money - they will tell you anything and everything - and none of it has to be true.

[Pugsy]

You really need to talk to Medicare about all this.
Yes...the two machines have the same HCPCS billing code numbers but the two machines do different functions for different problems. If there is a medical reason for the change there should be some way for Medicare to pay....but you need to go straight to Medicare and explain the problem.