[James T]

Rather than send filters out every month, can we send 3 months at a time?

[Sleeping410]

Taken directly from the PAP LCD. Hope this answers your question.




Quantities of supplies greater than those described in the policy as the usual maximum amounts will be denied as not medically necessary.

A supplier must not dispense more than a 3-month quantity of PAP accessories at a time.

Suppliers should stay attuned to atypical utilization patterns of their clients. A beneficiary or their caregiver must specifically request refills of PAP accessories before they are dispensed. The supplier must not automatically dispense a quantity of supplies on a predetermined regular basis, even if the beneficiary has "authorized" this in advance. As referenced in the Program Integrity Manual (Internet-Only Manual, CMS Pub. 100-8, Chapter 4.26.1) “Contact with the beneficiary or designee regarding refills should take place no sooner than approximately 7 days prior to the delivery/shipping date. For subsequent deliveries of refills, the supplier should deliver the DMEPOS product no sooner than approximately 5 days prior to the end of usage for the current product.”

[leejgbt]

Be sure to add a narrative to the claim for these items or they will be denied as too many.