The Centers for Medicare & Medicaid Services (CMS) has issued a reminder to organizations concerning Medicare payment for positive airway pressure (PAP) devices.
CMS notes that the Social Security Act prohibits payment for devices used to deliver continuous and/or bi-level PAP as items requiring frequent and substantial servicing, regardless of the illness the device is being used to treat.
Claims submitted for payment for such devices will be denied.
CMS goes on to state that using HCPCS codes E0450, E0460, E0461, E0463, E0464, E0465 or E0466 on a Medicare claim for a device to deliver PAP to a beneficiary is not allowed and could potentially violate the False Claims Act, even if the same device could be used as a ventilator for a different beneficiary.