HCPCS A7031: Face Mask Interface, Replacement for Full Face Mask

Learn how to properly use and bill for HCPCS code A7031, its documentation and billing requirements, from our short guide.

Use Code

## **What is HCPCS code A7031?** HCPCS code A7031, maintained by the Centers for Medicare and Medicaid Services (CMS), identifies the replacement interface or cushion for a full face mask utilized by patients undergoing Positive Airway Pressure Device (PAP) therapy for conditions like Obstructive Sleep Apnea (OSA). This code is specifically for the consumable component that seals against the patient's face, distinguishing it from codes that cover the entire mask system (like A7030). As a Durable Medical Equipment (DME) accessory, A7031 is subject to coverage rules tied to the base PAP device (e.g., E0601 or E0470) and must be medically necessary, generally aligning with a replacement frequency allowance, commonly established at one unit per month by major payers like Medicare, to ensure the continued effectiveness and hygiene of the prescribed therapy.

## **Documentation requirements** When billing A7031, providers must include: ## **Medical necessity** The patient's medical record must support the continued medical necessity for the base PAP device. This includes: - Initial diagnosis of a covered condition (e.g., OSA). - Documentation from the treating practitioner that the patient is compliantly using and benefiting from the PAP device. - For replacement supplies, documentation must show that the base equipment continues to meet the patient's medical needs. ### **Replacement justification** The supplier's documentation must support the need to replace the accessory (the face mask interface/cushion) to maintain the equipment's functionality and meet the beneficiary's medical needs. This typically means the old interface is worn out, causing leaks, or is no longer hygienic. ### **Order** A written or electronic order for the item must be on file.

## **Billing requirements** Here are the following requirements when billing for HCPCS code A7031: ### **Replacement schedule** Coverage is typically subject to a maximum replacement frequency to prevent excessive utilization. For A7031 (full face mask interface replacement), the typical allowable frequency for Medicare is one (1) per month. Note: This frequency may vary by payer (e.g., Medicaid, commercial insurance) and is subject to change based on policy updates. ### **Modifiers** Specific modifiers may be required for billing, such as: - **KX** (documentation on file proves all coverage criteria are met) - **NU** (new equipment) - **RR** (rental) Suppliers should consult the relevant Local Coverage Determination (LCD) and Policy Article for the appropriate Durable Medical Equipment Medicare Administrative Contractor (DME MAC). ### **Proof of delivery** Documentation proving the accessory was delivered to the beneficiary is required. ### **No charge to patient** If the claim for the base device (E0601, E0470, etc.) was denied as not medically necessary, the supplier generally cannot bill the beneficiary for the accessories (A7031) unless a properly executed Advance Beneficiary Notice of Noncoverage (ABN) was obtained.

## **Other relevant codes** - **A7030**: Full face mask used with a positive airway pressure device, each - **A7032**: Cushion for use on nasal mask interface, replacement only, each. - **A7033**: Pillow for use on nasal cannula type interface (nasal pillows), replacement only, pair - **A7034**: Nasal interface (mask or cannula type) used with a positive airway pressure device, with or without a head strap - **A7035**: Headgear used with positive airway pressure device (replacement straps) - **A7037**: Tubing used with positive airway pressure device

Frequently asked questions

A7031 is for the replacement cushion/interface only for a full face mask. A7030 is for the entire full face mask (frame, cushion, and headgear).

The standard Medicare replacement schedule for A7031 is once per month (1 per month). This is subject to the specific payer's policy.

The denial is often due to missing documentation, exceeding the allowed frequency, or the patient not meeting the required compliance for the base PAP machine. Review the denial reason and resubmit with corrected or additional documentation as needed. An ABN may also be required if non-coverage was anticipated.