| Average Medicare DSO (Days Sales Outstanding) By Product Category | DME (E0260, K0001, E0143, etc.) | 64 |
| Respiratory (E1390, J7619, E7619, etc.) | 48 | |
| Rehab (K0011, K0108, E0010, etc.) | 82 |
HCPCS Code A7035
(Headgear used with positive airway pressure device)
Average Medicare DSO
57 days
The A7035, headgear used with a positive airway pressure device, should only be billed once every six months per patient. This is the maximum amount Medicare considers medically necessary.
When billing for greater quantities of this accessory, documentation supporting medical necessity must be available to the Medicare contractor on request. Make sure to have this documentation before billing.
All claims submitted for A7035 must include the KX modifier, which indicates that the proper medical documentation to prove medical necessity is on file. A written, signed and dated order must be received by the supplier before a claim is submitted to the Medicare contractor.
Other documentation to keep on file in case of a post-pay audit include the sleep study and any physician progress notes that detail reasons for more than the allowed amounts for accessories or note special circumstances surrounding the patient's care as it relates to the CPAP and accessories.
Sarah Hanna is a reimbursement consultant and vice president of ECS Billing & Consulting, Tiffin, Ohio, and specializes in proper billing protocols, Medicare coverage guidelines and billing office procedures. She can be contacted at 419/448-5332 or sarahhanna@bright.net.
Data represents a categorized and weighted analysis of approximately 863,000 Medicare paid claim lines adjudicated by the Medicare contractors between Sept. 1, 2006, and Sept. 30, 2006, and processed for RemitDATA customers. Figures reflect the average number of days elapsed from date of service to Medicare check issue date. Source: RemitDATA, 866/885-2974, www.remitdata.com.
