Aetna pauses CPAP change
By HME News Staff
Updated 10:01 AM CDT, Thu March 27, 2025
WASHINGTON – Aetna has put a proposed change on hold for review after AAHomecare asked the insurer to reconsider using certain adherence codes that can only be billed by clinicians not DME providers.
The proposed change, announced in January, stated: “Beginning April 1, 2025, we’ll no longer reimburse the CPAP device or the supplies unless adherence to positive airway pressure therapy is documented using adherence codes G8851, G8854 and G8855 on the claim.”
“On behalf of DMEPOS suppliers and the millions of Americans who depend on high-quality, home-based CPAP care, we ask that you rescind the new adherence code requirement to prevent unintended disruptions in patient care,” AAHomecare stated in a letter to the insurer.
AAHomecare has requested formal communication from Aetna to the supplier community about the hold.
In the letter, AAHomecare pointed out that “G” codes identify health care procedures and services that may not have assigned CPT codes and are not listed in the PDAC, which identifies HCPCS codes that are billable by DME suppliers.
AAHomecare also noted that requiring an adherence code during the initial 90 days of use should not be required as compliance is still being determined. Additionally, the association wrote, it does not conform to provisions in the 2024 Medicare Advantage and Part D Final rule clarifying that MA plans cannot deny coverage based on criteria not found in traditional Medicare.
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