Retired - Respiratory Assist Devices – E0472
Joint DME MAC Article
Recently during claims review it was noted that suppliers are billing HCPCS code E0472 (Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)) with non-invasive interfaces. This is not correct billing. As noted in the code descriptor, code E0472 is reserved for devices used with an invasive interface. Claims for E0472 must not be billed with any of the following non-invasive interfaces or accessories:
| Code | Descriptor |
| A7027 | COMBINATION ORAL/NASAL MASK, USED WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE, EACH |
| A7028 | ORAL CUSHION FOR COMBINATION ORAL/NASAL MASK, REPLACEMENT ONLY, EACH |
| A7029 | NASAL PILLOWS FOR COMBINATION ORAL/NASAL MASK, REPLACEMENT ONLY, PAIR |
| A7030 | FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH |
| A7031 | FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH |
| A7032 | CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH |
| A7033 | PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY, PAIR |
| A7034 | NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HEAD STRAP |
| A7035 | HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE |
| A7036 | CHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE DEVICE |
| A7044 | ORAL INTERFACE USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH |
Claims for RAD use with a non-invasive interface are billed with HCPCS codes E0470 or E0471, depending on whether or not the device has a backup rate feature.
For questions about correct coding, contact the 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.
| Date | Revision |
|---|---|
| 02/18/2015 | Published on PDAC website |
| 02/10/2022 | Retired - Refer to the Respiratory Assist Devices LCD and Policy Article |