HCPCS Code A7033: Pillow for Use on Nasal Cannula-Type Interface, Replacement Only, Pair

Bill HCPCS code A7033 for replacement pillows used with nasal cannula-type CPAP or BiPAP masks. Learn documentation requirements, billing rules, and coding tips for compliant claim submission.

Use Code

## **What is a pillow for use on a nasal cannula-type interface?** HCPCS code A7033 is used to report replacement pillows for nasal cannula-type Continuous Positive Airway Pressure (CPAP) or Bilevel Positive Airway Pressure (BiPAP) interfaces. These are classified as durable medical equipment (DME) supplies and consist of soft silicone or gel cushions that sit just inside the nostrils to form a seal and deliver positive airway pressure (PAP). They are part of the nasal mask interface family and play a critical role in improving sleep quality for patients with obstructive sleep apnea and other sleep-related breathing disorders. Because the cushions are in direct contact with the nostrils and airflow, they wear out over time, losing their seal or becoming less hygienic. For this reason, payers such as Medicare and Medicaid services allow for regular replacement under A7033. A respiratory therapist or other qualified clinician often guides patients on when replacements are needed to maintain effective therapy and comfort. The unit of service for A7033 is defined as a pair. For some devices, this means two separate cushions—one for each nostril—while for others it is a single piece with two molded extensions. In both cases, one “pair” equals one billable unit. Importantly, A7033 is only for replacement pillows, not the full face mask, combination oral-nasal mask, or full face mask systems, which are reported under separate codes such as A7034. Coverage also depends on payer-specific rules and local coverage determinations (LCDs) that outline frequency limits and medical necessity criteria.

## **Documentation requirements for HCPCS code A7033** Medical records must clearly support that replacing nasal pillows is reasonable and necessary for the patient’s ongoing therapy. At a minimum, the following should be documented: - The patient’s diagnosis, such as obstructive sleep apnea or another condition requiring CPAP/BiPAP therapy. - A valid, signed, and dated order from the treating provider that specifies the supply (nasal pillow), frequency of replacement, and expected duration of therapy. - Evidence that the patient is actively using CPAP or BiPAP therapy, supported by clinical notes, download reports, or follow-up visits. - The type of interface used (nasal cannula-type) and confirmation that replacement pillows are needed rather than a full mask. - The number of units dispensed, converted correctly into “pairs” (1 pair = 1 unit). - The date of service and whether the item was provided as part of ongoing therapy. Note that if Medicare initially covered the base PAP device, medical necessity for the base device is assumed. Documentation must show that the base device is still in use and that replacing the pillows is essential for effective therapy. If Medicare did not pay for the base device, all standard coverage and documentation rules apply.

## **Billing requirements of HCPCS code A7033** Accurate billing ensures proper payment and prevents denials: - Bill A7033 by the pair, not by individual cushion. One pair (either two separate pillows or a single dual-prong piece) equals one unit of service. - Most payers, including Medicare, allow up to two units (pairs) per month as medically necessary replacements. Exceeding this frequency may result in denials unless well-documented. - Use CMS-1500 for professional claims or UB-04 for facility claims, with dates of service that match documentation. - Include the appropriate diagnosis code (e.g., OSA, ICD-10-CM G47.33) that supports the need for CPAP/BiPAP therapy. - Charges should reflect the actual item dispensed, and suppliers should retain invoices and proof of delivery. - For E0467 claims with dates of service before April 3, 2020, claims for A7033 or any of these related codes that are submitted on the same claim, or that overlap any date(s) of service for E0467, are considered unbundling and may be denied as not reasonable.

## **Other relevant codes** - **A7034**: Nasal interface (mask or cannula type) used with a positive airway pressure device, with or without head strap - **A7035**: Headgear used with positive airway pressure device - **A7037**: Tubing used with positive airway pressure device - **A7038**: Filter, disposable, used with positive airway pressure device

Frequently asked questions

Most payers, including Medicare, allow two units (pairs) per month. Frequency limits vary, so always check the patient’s specific coverage.

No. A7033 applies only to replacement pillows. The initial mask system is billed under A7034 or another appropriate mask code.

Even if the nasal interface is a single molded piece with two extensions, it is still billed as one pair (one unit). The billing rules apply the same as for two separate cushions.