Billing BIPAP, CPAP & Diabetic supply DME billing - A4223,A4230, K0552

BIPAP Devices

Use OPAS or submit form FH-1A to request continued services for BIPAP devices no sooner than 61 days and no later than 120 days after initiation of therapy. Form FH-1A or an attached physician’s note must contain a signed and dated statement declaring that the
recipient is:

• Compliantly using the device an average of 4 hours per 24 hour period; and
• Benefiting from its use

CPAP Devices

Use OPAS or submit form FH-1A to request continued services for CPAP devices no sooner than 61 days and no later than 120 days after initiation of therapy. The request must include all of the following:

• The number of hours a day the machine is used;
• The number of months the recipient has used the machine;
• Whether the recipient will continue to use the machine; and
• The name of the person who answered these questions (it can not be the DME
supplier).

Diabetic Supplies
Diabetic supplies are billed through the pharmacy program (provider type 28), not DME provider type 33.

The exceptions to this are as follows: insulin pumps (E0784) and insulin pump-related supplies (A4223, A4230, A4231 and K0552) or diabetic shoes/fittings/modifications (A5500 – A5513) which need to be billed through DME.

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