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Positive Airway Pressure Device – Diagnosis Required for Claim Submission

A positive airway pressure (PAP) device, E0601, is covered only for the treatment of obstructive sleep apnea (OSA) when the indications and limitations of coverage and/or medical necessity outlined in the PAP device local coverage determination (LCD) have been met. The only diagnosis code that supports coverage of a PAP device (E0601) is diagnosis code 327.23— Obstructive sleep apnea (adult) (pediatric). 

When billing for a PAP device, the supplier must enter the diagnosis code for the PAP device on each claim submitted for the PAP device as well as claims submitted for the related PAP accessories and supplies. 

The presence of covered diagnosis code 327.23 is not sufficient by itself to assure coverage. Suppliers must have medical record documentation within their files to support the medical need for the item being provided. Suppliers should refer to the section on Indications and Limitation of Coverage and/or Medical Necessity within the PAP LCD for other coverage criteria and payment information.

Positive Airway Pressure Device - Diagnosis Required for Claim Submission
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