Coding Update for Portable CPAPs
Tuesday, July 7, 2020
Last year, the Defense Health Agency (DHA) expanded the Continuous Positive Airway Pressure (CPAP) benefit under the Supplemental Health Care Program to allow active duty service members (ADSMs) who meet specific criteria to get portable CPAP machines when authorized. ADSMs require prior authorization for all CPAP devices. Health Net Federal Services, LLC (HNFS) has been issuing approvals for portable CPAP units using E0601, the Healthcare Common Procedure Coding System (HCPCS) code for a standard CPAP, and accepting E0601 on claims, due to the absence of a portable CPAP code. We recently received direction from DHA to accept HCPCS E1399 instead of E0601 for portable CPAP claims with dates of service on or after May 20, 2020.
We are working with DHA and the TRICARE East Region contractor, Humana Military, on a universal modifier specific to portable CPAPs that can be used when billing the unlisted E1399 code. We will send a follow-up communication once the modifier has been finalized.
Under the Supplemental Health Care Program, active duty service members can be authorized to receive a portable CPAP device if they meet the following criteria and this criteria is documented on the authorization request:
- The active duty service member has a diagnosis of obstructive sleep apnea (OSA); and
- The active duty service member travels on official business at least three days/month or is being deployed.
Portable CPAP devices must have humidification and battery capability.
If the service member already has a standard CPAP device, a portable device may be authorized if the criteria are met. However, once a service member has been authorized to receive a portable CPAP device, he or she won’t be eligible to receive a standard CPAP device in the future.
Visit our Continuous Positive Airway Pressure (CPAP) Machine benefits page for additional details.