New York Medicaid Unbundles PAP Supplies

ALBANY, N.Y. (May 12, 2022)—The New York State Medicaid department released their durable medical equipment (DME) manual update, effective June, 1 2022. Per the 202-page manual, all CPAP and BiPAP supplies that were formerly bundled with a new PAP set-up will be unbundled as of June 1.

Heated humidifiers (E0562) and cool humidifiers (E0561) were also unbundled from a new CPAP or BiPAP set up, and will be paid separately.

In addition, PAP devices can either be purchased or rented as a 10-month capped rental. If the member has a primary payer, the provider must submit an explanation of benefits from the primary payer according to Medicaid billing guidelines.

The Northeast Medical Equipment Providers Association’s (NEMEP) Payer Relations Committee, chaired by AAHomecare’s David Chandler, engaged New York Medicaid officials to secure these gains. NEMEP president John Quinlan deserves special recognition for his leadership in this effort. 

The NEMEP team is prioritizing these issues for continued advocacy with Medicaid leaders:

• Improving High Frequency Chest Wall Oscillation Device (HFCWOD E0483) payment policy;
• Improving back-up wheelchair and wheelchair repair policy; and
• Addressing other DME items with low fee-for-service reimbursement compared to surrounding states.

See pages 47-52 of the 2022 New York DME Manual for more on the PAP policies.

—Via AAHomecare