Wiki Medicare is not paying for A7045

[khartoum1900nile@aol.com]

Medicare keeps denying A7045: Exhalation port with or without swivel used with accessories for positive airway devices, replacement only. I have tried the following modifiers: NUKX and just NU and then no modifier. I looked up the following LCDs: L33718 and L33800. They offer no guidance on how to get this code to pay. The patient is on an Invasive Vent. Is the port considered New Equipment for NU to be used? Should I try the GZ modifier since medical necessity cannot be established? Has anyone had any luck getting Medicare to pay for this code?

 

[CBLENNIE]

It appears that A7045 is only covered for use with a CPAP machine, even if the ventilator is being used CPAP therapy. So you may not have a way of getting this reimbursed by Medicare.

The following information in L33800 is what leads me to believe this is the case because if they won't cover the ventilator when being used for CPAP therapy, they are unlikely to cover CPAP supplies for use with the ventilator.