How To Use HCPCS Code G8853

HCPCS code G8853 describes positive airway pressure therapy that is not prescribed. This code is used to indicate that the patient is receiving positive airway pressure therapy without a prescription from a healthcare provider. In this article, we will explore the details of HCPCS code G8853, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G8853?

HCPCS code G8853 is used to identify positive airway pressure therapy that is not prescribed by a healthcare provider. Positive airway pressure therapy is a treatment method used to help individuals with sleep apnea breathe more easily during sleep. It involves the use of a machine that delivers a continuous flow of air pressure through a mask worn over the nose or mouth. This constant air pressure helps to keep the airway open, preventing interruptions in breathing.

2. Official Description

The official description of HCPCS code G8853 is “Positive airway pressure therapy not prescribed.” This means that the patient is receiving positive airway pressure therapy without a prescription from a healthcare provider.

3. Procedure

1. The patient is fitted with a positive airway pressure (PAP) machine, which includes a mask that covers the nose or mouth.
2. The machine is set to deliver a specific level of air pressure, based on the individual’s needs.
3. The patient wears the mask and turns on the machine before going to sleep.
4. The machine delivers a continuous flow of air pressure throughout the night, keeping the airway open and preventing interruptions in breathing.
5. In the morning, the patient removes the mask and turns off the machine.

4. When to use HCPCS code G8853

HCPCS code G8853 should be used when the patient is receiving positive airway pressure therapy without a prescription from a healthcare provider. This may occur in cases where the patient obtains the therapy equipment and uses it without consulting a healthcare professional. It is important to note that positive airway pressure therapy should always be prescribed and monitored by a healthcare provider to ensure its effectiveness and safety.

5. Billing Guidelines and Documentation Requirements

When billing for positive airway pressure therapy using HCPCS code G8853, healthcare providers should ensure that the documentation includes the following:

• Proof that the therapy was not prescribed by a healthcare provider
• Date and duration of the therapy
• Details of the equipment used
• Any additional services or supplies provided in conjunction with the therapy

6. Historical Information and Code Maintenance

HCPCS code G8853 was added to the Healthcare Common Procedure Coding System on January 1, 2012. It has an effective date of January 1, 2017. This code was terminated on December 31, 2016, indicating that it is no longer in use. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G8853 may vary. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This could indicate that the service is not covered, bundled, or used by Part A only. The multiple pricing indicator code is 9, which means that it is not applicable as HCPCS is not priced separately by Part B or the value is not established. It is important for healthcare providers to check with Medicare and other insurers to determine the coverage and reimbursement policies for positive airway pressure therapy without a prescription.

8. Examples

Here are five examples of when HCPCS code G8853 should be billed:

1. A patient purchases a positive airway pressure therapy machine online without consulting a healthcare provider.
2. An individual borrows a positive airway pressure therapy machine from a friend or family member without a prescription.
3. A patient continues to use a positive airway pressure therapy machine after the prescription has expired.
4. An individual uses a positive airway pressure therapy machine without ever consulting a healthcare provider.
5. A patient obtains a positive airway pressure therapy machine from a non-medical source and uses it without a prescription.