DME rental charges....

[Aludj]

CPAP device: ResMed AirSense 10 with built-in, heated humidifier...

Apologies, if this question had been discussed, I could not find and answer...

In the beginning of the year, when the Medicare deductible hasn't been met as of yet, my DME supplier sent a statement for the rental charges:

1. CPAP Autoset Airsense 10
   
2. CPAP Humidifier AirSense Built in
   

Is this normal to charge rental for the CPAP device and the built-in humidifier separately?

The interesting part is looking at the February and March MSNs, the only rental listed is the ResMed AirSense, no humidifier listed.

Randomly looking at 2020 MSNs, some of them shows the humidifier as "not covered", while others do state that it is "covered"; yet a third-version, humidifier rental is not in the MSN.

This issue had been discussed with Medicare and couldn't get a straight answer out of them. Some of Medicare rep even stated, that the humidifier has a five years rental period, prior to owning it. That seem strange, after the rep has stated the AirSense 10 rental period as 13 month.  

Does anyone have insight for the CPAP rental charges?

TIA...

PS: MSN: Medicare Summery Notice....

[Melman]

I paid separately for the machine and the humidifier. From previous posts in the forum I believe this is typical. There are separate charging codes fro the machine and humidifier since humidifiers can be purchased separately as a replacement item. DMEs seem to take advantage of this to increase their profits.

[greatunclebill]

Normally the cpap is 13 month rent to own deal. the humidifier is always a separate one time purchase.

[SarcasticDave94]

Yes it's typical. Like mentioned by greatunclebill, the PAP machine will rent for 13 months while the humidifier is paid for in the first bill.

[Aludj]

Yes it's typical. Like mentioned by greatunclebill, the PAP machine will rent for 13 months while the humidifier is paid for in the first bill.

I don't doubt, that you and others are correct, but...

Then why are DME companies charging rental fee for humidifier? How does it make sense? If I go rouge and purchase an "AirSense™ 10 AutoSet™ with Integrated Humidifier and Heated Hose" for about 5 - 6 "C" notes, I don't own anyone five years rental for the humidifier. Not to mention, that it isn't really a humidifier in the conventional sense. It's just a warming plate and should be billed as such, or stove in extreme cases.

I am going back to Medicare to further discuss this with them, maybe even filing a complaint against the DME company. Especially, if the first MSN shows that the humidifier had been paid for by Medicare over a year ego...

[SarcasticDave94]

I think in part, items like the humidifier are separate line item charges because older PAP models had the humidifier as an add-on accessory. The DME's haven't changed this on models like ResMed 10s with integrated humidifier, because it inflates the pricing.

[greatunclebill]

please call medicare. please come back to this thread and let us know what medicare tells you and what happens with the dme.

[SarcasticDave94]

Yes ditto from me. Update us please. I'm on regular alpha and bravo Medicare.

[Aludj]

Yes ditto from me. Update us please. I'm on regular alpha and bravo Medicare.

Oh, the alphabet-soup of US healthcare...

Mine is regular alpha, bravo, delta, mike... staying far away from charlie...

I did look in to the issue and hate to admit, but it's on Medicare and not on the DME.

The HCPCS code for humidifier is E0562 (Humidifier, heated, used with positive airway pressure device) is in effect since 01.01.04. You usually see this code with RRKX modifiers in the MSN:

• RR: Rental Equipment
  
• KX: Medically necessary
  

The HCPCS code for the CPAP machine is E0601 (Continuous positive airway pressure (CPAP) device) is in effect since 01.01.14. This code may have the same modifier in your MSN as above, plus the KI modifier that indicates the rental month some weird way.

Technology for sleep apnea treatment advanced a lot during the last decade, even if the CPAP machines are principal the same. Medicare didn't keep up with this technology and these codes are the only ones that the DME can charge the Medicare for.

I am in the process to file a complaint with Medicare, more like bringing this to their attention and recommend changing the codes for the CPAP humidifier. It does not make sense, that CPAP machines with builtin humidifier have two rental charges. And to make it even worse, the CPAP machine with builtin humidifier required to comply with two "rent-to-own" time limits, 13 and 60 month respectively. That's just crazy and members certainly have and will have hard time complying with these requirements.

Filing a complaint is rather fast online, but the response will take some time. Should Medicare accept the recommendation and proceed with implementation, the earliest time frame for the new HCPCS code to become effective is probably 01.01.23. If you guys have suggestion for what to include in the complaint, please let me know. I may also reach out to you, if I need help.

Thanks...

[sheepless]

it's a loophole used at our expense that will continue until enough people complain. my experience here:

http://www.apneaboard.com/forums/Thread-...vercharges