July 7, 2022

State of Alabama
Press Release: Medicaid

Update for Continuous Positive Airway Pressure (CPAP) Device and Bilateral Positive Airway Pressure (BIPAP) Device Policy due to National Shortage of CPAP and BIPAP Devices



TO: DME Providers, Prosthetics & Orthotics (P&O) Providers, Pharmacies, Physicians, Physician Assistants, Nurse Practitioners, and Nursing Homes

RE: Update for Continuous Positive Airway Pressure (CPAP) Device and Bilateral Positive Airway Pressure (BIPAP) Device Policy due to National Shortage of CPAP and BIPAP Devices

Effective August 1, 2022, Alabama Medicaid will make changes to the CPAP/BIPAP/Humidifier prior authorization (PA) policy. Effective for PAs with dates of service on or after August 1, 2022, Alabama Medicaid will:

  1. No longer require the compliance requirement in the Medicaid CPAP and BIPAP criteria during the national supply issue.  Alabama Medicaid will re-evaluate in the future to determine if Medicaid should return to compliance requirements.  
  2. No longer require a rental period for CPAP and BIPAP devices. CPAP and BIPAP devices will be billed as a ‘straight purchase’ during the national supply issue. Alabama Medicaid will re-evaluate in the future to determine if Medicaid should return to compliance requirements.  
  3. Update the Medicaid max allowed quantity for PAP supplies. The chart below lists the updated maximum quantity allowed for each supply effective August 1, 2022: 
   
Procedure      CPAP Supplies Max Units
Code
A7030 Full mask for CPAP with airway pressure device 1 per 3 months
A7031 Face mask interface, replacement for full face mask 1 per month
A7032 Replacement cushion for nasal application device, each 2 per 1 month
A7033 Replacement pillows for nasal application device, pair 2 per 1 month
A7034 Nasal interface (mask or cannula type) used with CPAP 1 per 3 months
A7035 Headgear used with positive airway pressure device 2 per year
A7036 Chin strap used with CPAP           2 per year
A7037 Tubing for CPAP             1 per month
A7038 Filter, disposable, used with CPAP             2 per month
A7039 Filter, non-disposable, used with CPAP 2 per year
A7044 Oral interface used with CPAP 2 per year
A7046 Replacement chamber for heated humidifier             2 per year
E0550              Humidifier, durable for extensive supplemental 1 per month
                        humidification during IPPB treatments or oxygen delivery  
E0561              Humidifier, non-heated, used with positive airway   1 per 8 years              
pressure device
E0562              Humidifier, heated, used with positive 1 per 8 years
                        airway pressure device    

4. Providers will continue to bill claims for CPAP or BIPAPs as rent to purchases with PAs that are effective with dates of           service prior to August 1, 2022. For claims with existing/remaining rental months, providers should submit a PA for the      remaining amount and purchase. CPAPs and BIPAPs will no longer be allowed to be billed as rental items effective August 1, 2022. 

5. As a reminder, providers can bill for CPAP, humidifier devices, and masks separately when billed on the same date of service. Please refer to ALERT here: https://medicaid.alabama.gov/alert_detail.aspx?ID=14043. 

Reminder: CPAP/BIPAP therapy is covered through the EPSDT Program for children up to the age of 21. Requests for Medicaid’s authorization of a replacement CPAP/BIPAP device will be accepted for review every eight years. A request for replacement of the device submitted within less than 8 years which is due to a natural disaster, or an occurrence beyond the recipient’s control, and not the result of misuse, neglect or malicious acts by the user may be considered for approval and payment. The provider must obtain a PA, submit the claim electronically to Gainwell Technologies for processing with the appropriate procedure code and Modifier CR, and keep all documentation in the recipient file. 

Policy questions concerning this provider notice should be directed to the DME Program at 
(334) 242-5050.

Questions concerning DME prior authorizations should be directed to Kepro at 1-800-426-7259 
or 1-800-472-2902. 



The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2022 American Medical Association
and © 20
22 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.





  • For more information, visit http://medicaid.alabama.gov
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