Coding Update for Portable CPAP Machines
Monday, October 12, 2020
Last year, the Defense Health Agency (DHA) expanded the Continuous Positive Airway Pressure (CPAP) benefit under the Supplemental Health Care Program to allow active duty service members (ADSMs) who meet specific criteria to get portable CPAP machines when authorized (ADSMs require prior authorization for all CPAP devices).
We previously advised you we were working with DHA and the TRICARE East Region contractor, Humana Military, on a universal modifier specific to portable CPAPs for billing purposes. It has since been determined a universal modifier will not be established. Providers should continue to bill using Healthcare Common Procedure Coding System (HCPCS) code E1399 for portable CPAP claims with dates of service on or after May 20, 2020.
Learn more about TRICARE’s CPAP benefit, including authorization details, on our CPAP details page.