💨 CPAP / BiPAP Upgrade Quick Reference
Effective: 8/27/24 + 10/1/24 Updates
For: BCBS · Aetna (now = Medicare CBA) · Medicare (CBA / Rural)
😴 Mask & Headgear Upgrades
| Mask / Item | Payer | Pillows / Cushion | Frame | Headgear | HG Only |
|---|
| ResMed P30i | Aetna = Medicare CBA | $7 ea (A7033) | $21 (A7034) | $15 (A7035) | $18 |
| BCBS | $11 ea | $32 | $12 | $23 |
| Medicare CBA | $7 ea | $21 | $15 | $18 |
| Medicare Rural | — | — | — | No upgrades |
| ResMed F20 AirFit | Aetna = Medicare CBA | — | — | — | $20 HG only |
| BCBS | $7.37 | $16.30 | $5 | $25 |
| Medicare CBA | — | — | — | $20 HG only |
| Medicare Rural | — | — | — | No upgrades |
| ResMed P10 | Aetna = Medicare CBA | — | — | — | $18 HG only |
| BCBS | $4.73 | $11.48 | $5 | $23 |
| Medicare CBA | — | — | — | $18 HG only |
| Medicare Rural | — | — | — | No upgrades |
| ResMed N20 / N30 | Aetna = Medicare CBA | $5 ea (A7032) | $10 (A7034) | $5 (A7035) | $15 HG only |
| BCBS | $10 | $20 | $10 | $23 |
| Medicare CBA | $5 ea | $10 | $5 | $15 HG only |
| Medicare Rural | — | — | — | No upgrades |
💰 PAP Machine OOP (Aetna / BCBS)
| Device | Aetna = Medicare CBA | BCBS | Medicare |
|---|
| AirSense 10/11 AutoCPAP | $350 | $150 | — |
| AirCurve 10/11 AutoBiPAP | $550 | $250 | — |
| AirCurve 10 ST (w/ Backup) | $1950 | $1600 | — |
| AirCurve 11 ASV | $2350 | $2000 | $500 |
| Heated Hose (A4604) | +$16 OOP | +$16 OOP | — |
| Water Chamber (A7046) | +$20 Upgrade | +$20 Upgrade | — |
| Non-Heated Hose | — | — | No OOP |
💤 Philips & Amara View
| Product | Payer | Upgrade / Note |
|---|
| DreamWear UTN & FFM | Aetna = Medicare CBA | Covered (no upgrade; deductible/copay may apply) |
| Amara View | Medicare | $10 per cushion (A7031) |
| BCBS | $15 per cushion |
| Aetna = Medicare CBA | $10 per cushion |
| — | Recommend switching to DreamWear FFM – $10 cheaper per cushion |
😷 Philips DreamWisp (Aetna = Medicare CBA)
| Item | HCPCS | Upgrade |
|---|
| Cushion | A7032 | $5 ea |
| Frame | A7034 | $10 |
| Headgear | A7035 | $5 |
- “HG” = Headgear · “OOP” = Out-of-Pocket · “CBA” = Competitive Bidding Area
- Aetna now follows Medicare CBA pricing for all upgrades.
- Verify payer policy before quoting prices — updates may occur.
- All upgrades require standard documentation and ABN when applicable.
Internal Reference — Updated 08/27/24 & 10/01/24
Not for patient distribution