HCPCS A7038: Filter, Disposable, Used With Positive Airway Pressure Device

Learn how to properly use and bill for HCPCS code A7048 with our short guide.

## **What is HCPCS code A7038?** HCPCS code A7038 designates a Filter, disposable, used with a respiratory assist device, specifically, a positive airway pressure (PAP) device (such as Continuous Positive Airway Pressure device or Bilevel Positive Airway Pressure Device). This supply code, maintained by Centers for Medicare and Medicaid services (CMS) covers the regular replacement of the disposable air filter necessary for the proper operation of the PAP device. The purpose of these filters for oxygen equipment is critical: they ensure that the pressurized air delivered to the patient for treating conditions like Obstructive Sleep Apnea (OSA) is clean, contaminant-free, and optimal for therapy, thereby maintaining device efficacy and preventing potential respiratory irritation or infection. As a Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) item, billing for A7038 requires strict adherence to payer guidelines, often involving a maximum allowed quantity (commonly 2 per 30 days) that must be supported by a prior, signed Standard Written Order (SWO) from the treating physician. Suppliers must verify continued need and secure authorization from the beneficiary before dispensing refills, as the coverage for this accessory is dependent upon the patient's ongoing, medically necessary use of the primary PAP device.

## **Documentation requirements** The Centers for Medicare & Medicaid Services (CMS) and Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have specific requirements for billing DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) items like A7038. Key documentation generally includes: ### **Standard Written Order (SWO)** A signed and dated order from the treating physician must be received by the supplier before submitting a claim. This order should include: - Beneficiary's name or Medicare Beneficiary Identifier (MBI). - Order date. - A description of the item (e.g., "Filter, disposable," the HCPCS code A7038, or the long narrative). - Treating Practitioner's name or NPI and signature. ### **Medical necessity** The patient's medical record must document the underlying condition (e.g., a diagnosis of Obstructive Sleep Apnea, ICD-10 code G47.33) that requires the use of the PAP device. ### **Documented refill request** For recurring supplies like disposable filters, the supplier must contact the beneficiary prior to dispensing the refill to confirm the item is still reasonable and necessary, existing supplies are approaching exhaustion, and to confirm any changes to the order. This is a crucial step to avoid denial of the claim. ### **Proof of Delivery (POD)** Documentation confirming the date the item was delivered to the beneficiary, including the quantity and a description of the item, and the signature of the person accepting delivery.

## **Billing requirements** Billing for HCPCS code A7038 must adhere to the rules for DMEPOS supplies: - **Frequency/quantity limit**: The usual maximum frequency for A7038 (disposable filters) is typically 2 per 1 month (or two filters every 30 days), as established in various Local Coverage Determinations (LCDs) for PAP supplies. Claims for quantities exceeding the maximum may be denied as not medically necessary. - **Billing basis**: Billing of PAP accessories must be based on prospective use, not retrospective. The supplier must not automatically ship on a predetermined basis without a documented refill request from the beneficiary. - **Date of Service (DOS)**: The DOS on the claim is generally the date of delivery. - **Modifiers**: Depending on the payer's payment rules and specific circumstances, certain modifiers may be required. - **Coverage**: A7038 is typically covered only if the underlying PAP device (e.g., E0601, E0470) is covered and the criteria for its use are met.

## **Other relevant codes** - **A7030**: Full face mask used with positive airway pressure device, each - **A7031**: Face mask interface, replacement for full face mask, each - **A7032**: Cushion for use on nasal mask interface, replacement only, each - **A7034**: Nasal interface (mask or cannula type), with or without head strap - **A7037**: Tubing used with positive airway pressure device - **A7039**: Filter, non-disposable (reusable), used with positive airway pressure device - **E0601**: Continuous positive airway pressure (CPAP) device - **E0470**: Respiratory assist device (BiPAP), bilevel pressure capability, without backup rate feature

Frequently asked questions

A7038 is for a disposable filter, typically changed more frequently (e.g., twice a month), while A7039 is for a non-disposable or reusable filter, which is meant to be cleaned and replaced less often (e.g., once every six months).

No. Suppliers must contact the patient before dispensing a refill to ensure they are still using the equipment, the items are approaching exhaustion, and they confirm the order is still needed. Automatic or "pre-determined" shipping without a valid, documented refill request is a common reason for claim denial.

Not usually for Medicare, but some commercial payers may require prior authorization for PAP supplies.