HCPCS A7029: Nasal Pillows for Combination Oral/Nasal Mask, Replacement Pair - OpenPayer

Summary & Overview

HCPCS A7029: Nasal Pillows for Combination Oral/Nasal Mask, Replacement Pair

HCPCS Level II code A7029 designates replacement nasal pillows sold as a pair for combination oral/nasal masks used with positive airway pressure therapy. This code matters nationally because replacement mask components are a recurring, necessary supply for patients managing sleep-disordered breathing; appropriate coding affects coverage, supply continuity, and durable medical equipment workflows across payers. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what A7029 represents, how it fits into PAP device supply chains, and the payer landscape relevant to durable medical equipment and mask component reimbursement. The publication summarizes benchmarks where available, highlights common coding considerations for replacement-only components, and situates the code within clinical context for patients using combination oral/nasal masks. It also identifies gaps where specific payer policy details, taxonomies, and diagnosis linkage are not provided in the input. The intent is to help billing and compliance staff, DME suppliers, and policy analysts understand the code’s purpose, likely sites of service, and which major payers commonly interact with this supply category.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA7029HCPCS Level IInasal pillowsPAP therapydurable medical equipmentmask replacementsleep-disordered breathingDME coding

Billing Code Overview

HCPCS Level II code A7029 describes nasal pillows for combination oral/nasal mask, replacement only, pair. The service type is replacement nasal pillows intended as component replacements for a combination oral/nasal positive airway pressure (PAP) mask. The typical site of service is home use or durable medical equipment supply, where replacement mask components are provided to patients using PAP therapy for sleep-disordered breathing.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with obstructive sleep apnea (OSA) uses a combination oral/nasal continuous positive airway pressure (CPAP) mask. During a routine durable medical equipment (DME) follow-up visit, the respiratory therapist documents worn and damaged nasal pillows on the existing mask interface. The therapist removes the old nasal pillows and replaces them with a new pair of nasal pillows billed as replacement components. The patient demonstrates proper fit and seal and is instructed on cleaning and periodic replacement schedules. Typical site of service is an outpatient DME supply clinic or a home health visit when a home respiratory therapist performs the replacement. Billing is limited to replacement of the nasal pillows only, supplied as a pair, and coded using A7029 for reimbursement and inventory tracking.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier required/unspecified	Rarely appended; use payer-specific convention for DME supplies when no modifier applies.
`22`	Increased procedural services

HCPCS A4372: Ostomy Skin Barrier, Solid 4 x 4 with Convexity

HCPCS-A6228-STERILE-SALINE-IMPREGNATED-GAUZE-PAD-16SQIN

HCPCS A6228: Sterile Saline-Impregnated Gauze Pad, ≤16 sq in

HCPCS-A4638-REPLACEMENT-BATTERY-EAR-PULSE-GENERATOR

HCPCS A4638: Replacement Battery for Ear Pulse Generator

HCPCS-A6442-CONFORMING-BANDAGE-NON-ELASTIC-LESS-THAN-3IN-PER-YARD

HCPCS A6442: Conforming Non-Elastic Bandage <3" Width, Per Yard

HCPCS-A4720-DIALYSATE-SOLUTION-PERITONEAL-DIALYSIS-250-999CC

HCPCS Level II A4720: Dialysate Solution for Peritoneal Dialysis (>249–999 cc)

HCPCS-A6572-GRADIENT-COMPRESSION-GARMENT-TOE-CAP

HCPCS A6572: Gradient Compression Garment, Toe Cap, Each

HCPCS-A4510-SURGICAL-STOCKINGS-FULL-LENGTH

HCPCS A4510: Surgical Stockings, Full Length, Each

HCPCS-A4456-ADHESIVE-REMOVER-WIPE-SINGLE-USE

HCPCS A4456: Adhesive Remover Wipe, Single-Use

HCPCS-A4672-DRAINAGE-EXTENSION-LINE-DIALYSIS

HCPCS A4672: Drainage Extension Line for Dialysis

HCPCS-A6199-ALGINATE-WOUND-FILLER-STERILE-6-INCH

HCPCS A6199: Alginate Wound Filler Dressing, Sterile, per 6 inches

Showing 1–10 of 633

Taxonomy Code	Specialty	Notes
`Respiratory Therapist`	Respiratory Therapy	Primary clinician for CPAP interface fitting, supply replacement, and patient education.
`Pulmonology`	Pulmonary Disease	Prescribing and overseeing OSA therapy and DME orders.
`Sleep Medicine`	Sleep Medicine Specialist	Evaluation and follow-up of OSA patients, device setup and adjustments.
`Durable Medical Equipment Supplier`	DME Supplier	Supplies and ships replacement nasal pillows; documents warranty and replacement intervals.
`Primary Care`	Family Medicine/Internal Medicine	Coordinates DME prescriptions and routine follow-up for therapy adherence.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G47.33`	Obstructive sleep apnea (adult)	Primary indication for CPAP therapy; nasal pillows are a mask interface component used by patients with this diagnosis.
`G47.31`	Primary central sleep apnea	May use positive airway pressure therapy with mask interfaces that include nasal pillows depending on device and patient needs.
`R06.81`	Nasal obstruction	Nasal interface comfort and fit may be affected by nasal obstruction, influencing choice and replacement frequency of nasal pillows.
`J30.1`	Allergic rhinitis due to pollen	Allergic nasal symptoms can increase mask leaks or degrade nasal pillows, prompting replacement.
`Z99.11`	Dependence on respirator [ventilator] status post-procedure (example DME dependence)	Represents dependence on respiratory support; included as a high-level marker when durable respiratory equipment is part of ongoing care.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`94660`	Continuous positive airway pressure ventilation (CPAP), initiation and management	Performed when initiating CPAP therapy; may precede or accompany initial mask fitting and supply selection that later requires replacement pillows.
`94664`	CPAP equipment management and data download at least 30 days after initiation	Used during follow-up visits to assess therapy efficacy and mask leak, which can drive replacement of nasal pillows.
`99070`	Supplies and materials (except spectacles), noncovered items, used during the visit	May be used by a clinician to bill for small non-DME supplies provided during a visit when payer allows; DME suppliers usually bill `A7029` for the nasal pillow pair.
`94760`	Noninvasive airway pressure therapy, initiation or management (alternate descriptor depending on payer)	Used in some clinical workflows for CPAP/BiPAP setup and management that include mask fitting and supply replacement.
`93010`	Electrocardiogram, routine ECG with interpretation and report (used as example of unrelated monitoring)	Not typically directly related but may be performed in pre-procedure assessments in complex patients; included here only as occasionally paired testing in sleep clinics.

OpenPayer