DME Providers: Clarification on Face Mask Benefit

January 17, 2012

In line with Medicare and industry standards, as of September 1, 2010 MaineCare claims for A7031, “Face mask interface, replacement for full mask” may be reimbursed at one (1) unit, per member, per month. This replaces the current policy of one (1) unit, per member, per three (3) months.

Previously, claims for Continuous Positive Airway Pressure (CPAP) and Bi-level Positive Airway Pressure (Bi-PAP) Supplies that were submitted for a member more frequently than every three (3) months were denied. These claims will be automatically reprocessed for dates of service September 1, 2010 and later. You do not need to resubmit claims denied between September 1, 2010 and December 28, 2011.

You can view the policy Chapter II, Section 60 of the MaineCare Benefits Manual or the Clarification Letter dated 1/09/12. If you have questions about the policy, you can call 1-866-690-5585, option 1 and ask to be connected to your Provider Relations Specialist.