Replacement face mask interface for full face masks

Description

This code represents a replacement interface specifically designed for full face masks used in respiratory therapy. It is billed per unit and is essential for ensuring proper fit and function in patients requiring continuous positive airway pressure (CPAP) or other ventilatory support.

Medicare Hospital Outpatient Reimbursement (OPPS)

OPPS Payment Rate

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Patient Copayment / Coinsurance

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Top Modifiers

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HCPCS/CPT NUPurchase of new durable medical equipment(99.74%)

HCPCS/CPT KXDocumentation requirements met for DMEPOS items(64.04%)

HCPCS/CPT GZItem or service expected to be denied as not reasonable and necessary(8.82%)

HCPCS/CPT GAWaiver of liability statement issued per payer policy(4.2%)

HCPCS/CPT CRCatastrophe or disaster-related service modifier(3.42%)

HCPCS/CPT GWService unrelated to hospice patient's terminal condition(2.65%)

HCPCS/CPT CCProcedure code change due to administrative or filing error(1.88%)

HCPCS/CPT GYItem or service excluded from Medicare benefits(0.94%)

HCPCS/CPT KTItem provided by non-contract supplier in non-competitive bidding area(0.77%)

HCPCS/CPT EYItem or service without physician order(0.51%)

Code Crosswalks

No crosswalks found.

Alternate Codes

No alternates found.

Billed With Codes

No codes found here.

Sources

We make no claims to ownership of the coding systems referenced on this platform. Codes and descriptions are produced from claims and chargemaster data available through the CMS-9915-F Transparency in Coverage Final Rule and via state or federal datasets. This service is provided solely as a reference to encourage use of these codes in our chargemaster review and automated billing tools, so that healthcare professionals can understand and correctly report these codes in their claims.

Federal and State Datasets

List of CPT/HCPCS Codes, Centers for Medicare & Medicaid Services (CMS)
HCPCS Quarterly Update, Centers for Medicare & Medicaid Services (CMS)
Physician Fee Schedule Relative Value Files, Centers for Medicare & Medicaid Services (CMS)
OPPS Addendum B, Centers for Medicare & Medicaid Services (CMS)
ASC Payment Addenda, Centers for Medicare & Medicaid Services (CMS)