Instruction manual

Medicare Capped Rental Information for CPAP/BiPAP/VPAP (ow generator)
This information is provided to help the user understand how Medicare pays for these types of durable medical
equipment. Medicare will purchase the humidier, tubing, mask and headgear. Only the ow generator is a
rental item.
Months 1-3
Medicare will pay 80% of the Medicare-allowed amount from the Medicare fee schedule. The allowed amount
varies from state to state.
For Example
$135.45 Monthly rental of the device
$105.29 Medicare allowable
$84.23 Medicare pays 80%
$21.06 Remainder of allowable
If no other insurance, it is patient’s responsibility. If there is a supplement, it may pay 80% of the
20% Medicare doesn’t pay, or in some cases, all of what Medicare doesn’t pay.
Months 4-13
Medicare reduces the allowed amount from the fee schedule by 25%. The amount paid by Medicare is 80% of the
reduced allowed amount.
For Example
$135.45 Monthly rental of the device
$78.92 Medicare allowable
$63.14 Medicare pays 80%
$15.78 Remainder of allowable
If no other insurance, it is patient’s responsibility. If there is a supplement, it may pay 80% of the
20% Medicare doesn’t pay, or in some cases, all of what Medicare doesn’t pay.
After the 13th month billing is completed, the patient has ownership of the
flow generator
You will receive a letter at approximately three months and six months asking if you are using the equipment. We
must document that you are continuing to use the equipment. We must have this documentation in our les to
facilitate billing to Medicare. It is very important for you to return these letters promptly. If you are not using the
equipment, you may need to return it.
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