HCPCS Level II A7030: Full Face Mask for Positive Airway Pressure Device

Commercial payers pay $109 on average nationally for this procedure.

HCPCS Level II code A7030 describes a full face mask used with a positive airway pressure (PAP) device, a durable medical device accessory intended to deliver PAP therapy by covering both nose and mouth; service type is device/supplies for PAP therapy and the typical site of service is home or sleep clinic use for patients requiring noninvasive ventilatory support during sleep or respiratory insufficiency management.

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National Reimbursement Benchmarks

National commercial pricing for HCPCS A7030 centers near BUCA’s average commercial rate of $108.70, with payer medians and means varying noticeably. Blue Cross Blue Shield posts the widest dispersion (P75 $136.50 minus P25 $97.80 = $38.70), indicating broader negotiated outcomes, while Aetna shows the tightest IQR (P75 $100.60 minus P25 $76.00 = $24.60), suggesting more compressed commercial pricing around its median of $86.40.

UnitedHealth Group and Cigna fall between those extremes: UnitedHealth Group’s interquartile spread is $50.04 (P75 $122.60 minus P25 $67.60), and Cigna’s spread is $59.30 (P75 $132.60 minus P25 $71.30), reflecting substantial midrange variability. BUCA’s mean of $108.70 anchors the market average without min/max values provided, while individual payers demonstrate meaningful dispersion that can affect contract comparisons.

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HCPCS Level II A7030: Full Face Mask for Positive Airway Pressure Device

Commercial payers pay $109 on average nationally for this procedure.

Customize your policy alerts

Sign up for hcpcs A7030 policy alerts

Get alerted when payer policies referencing A7030 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 62-year-old male with a history of chronic obstructive pulmonary disease (J44.9) and chronic respiratory failure with hypoxia (J96.10) is evaluated in the pulmonary clinic for worsening dyspnea and nocturnal desaturation. Home oxygen therapy is in place; overnight pulse oximetry shows recurrent desaturation and polysomnography confirms moderate obstructive sleep apnea (G47.33). The pulmonologist and respiratory therapist determine the patient would benefit from initiation of positive airway pressure therapy using a full face mask due to chronic nasal congestion and mouth breathing. The full face mask (A7030) is delivered by a durable medical equipment (DME) supplier and fitted by a respiratory therapist in the outpatient DME clinic. Training on device use, cleaning, and mask fit adjustments is provided. Follow-up includes remote adherence monitoring and clinic reassessment for mask comfort, skin integrity, and effectiveness in relieving hypoxia and dyspnea. Typical payors for billing include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`A7034`	Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap	Alternative interface type; may be billed when a nasal mask is provided instead of a full face mask or when a patient transitions between interfaces.

Related Modifiers

5 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207RP1001X	Pulmonary Disease Physician	An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational an…
227900000X	Registered Respiratory Therapist	A Registered Respiratory Therapist (RRT) is an advanced therapist who has passed standardized written and clinical simulation examinations administere…
2278C0205X	Critical Care Certified Respiratory Therapist	Respiratory emergencies are commonplace in the treatment of critical care patients. Included in the assessment measurements conducted by the respirat…
320700000X	Physical Disabilities Residential Treatment Facility	A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with physical disabilities and…
207XX0801X	Orthopaedic Trauma Physician	Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic trauma surgeons deal with the eval…
173C00000X	Reflexologist	Reflexologists perform a non-invasive complementary modality involving thumb and finger techniques to apply alternating pressure to the reflexes withi…
2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	A pediatrician who specializes in the treatment of individuals with developmental delays and learning disorders associated with cerebral palsy, spina …
2085U0001X	Diagnostic Ultrasound Physician	A Radiology doctor of Osteopathy that specializes in Diagnostic Ultrasound.

Related ICD-10-CM Codes

5 rows

ICD-10-CM Code	Description
J96.10	Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia
J96.11	Chronic respiratory failure with hypoxia
J44.9	Chronic obstructive pulmonary disease, unspecified
G47.33	Obstructive sleep apnea (adult) (pediatric)
R06.02	Shortness of breath

Related Codes

HCPCS-A4206-STERILE-SYRINGE-1CC-NEEDLE

HCPCS A4206: Syringe with Needle, 1 cc or Less, Sterile

HCPCS-A4207-STERILE-2CC-SYRINGE-WITH-NEEDLE

HCPCS Level II A4207: Syringe with Needle, Sterile 2 cc

HCPCS-A4208-STERILE-3CC-SYRINGE-WITH-NEEDLE

HCPCS Level II A4208: Syringe with Needle, Sterile 3 cc

HCPCS-A4209-STERILE-SYRINGE-WITH-NEEDLE-5CC-OR-GREATER

HCPCS Level II A4209: Syringe with Needle, Sterile 5 cc or Greater

HCPCS-A4210-NEEDLE-FREE-INJECTION-DEVICE

HCPCS Level II A4210: Needle-free Injection Device, Each

HCPCS-A4211-SUPPLIES-SELF-ADMINISTERED-INJECTIONS

HCPCS Level II A4211: Supplies for Self-Administered Injections

HCPCS-A4212-NON-CORING-NEEDLE-STYLET-CATHETER-ACCESS-SUPPLY

HCPCS Level II A4212: Non-coring Needle or Stylet with/without Catheter

HCPCS-A4213-STERILE-SYRINGE-20CC-OR-GREATER

HCPCS Level II A4213: Syringe, Sterile, 20 cc or Greater, Each

HCPCS-A4215-STERILE-NEEDLE-SINGLE-EACH

HCPCS Level II A4215: Needle, Sterile, Any Size

HCPCS-A4216-STERILE-DILUENT-FLUSH-10ML

HCPCS Level II A4216: Sterile Diluent/Flush, 10 ml

Showing 1–10 of 633

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`A7034`	Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap	Alternative interface type; may be billed when a nasal mask is provided instead of a full face mask or when a patient transitions between interfaces.

Related Modifiers

5 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207RP1001X	Pulmonary Disease Physician	An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational an…
227900000X	Registered Respiratory Therapist	A Registered Respiratory Therapist (RRT) is an advanced therapist who has passed standardized written and clinical simulation examinations administere…
2278C0205X	Critical Care Certified Respiratory Therapist	Respiratory emergencies are commonplace in the treatment of critical care patients. Included in the assessment measurements conducted by the respirat…
320700000X	Physical Disabilities Residential Treatment Facility	A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with physical disabilities and…
207XX0801X	Orthopaedic Trauma Physician	Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic trauma surgeons deal with the eval…
173C00000X	Reflexologist	Reflexologists perform a non-invasive complementary modality involving thumb and finger techniques to apply alternating pressure to the reflexes withi…
2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	A pediatrician who specializes in the treatment of individuals with developmental delays and learning disorders associated with cerebral palsy, spina …
2085U0001X	Diagnostic Ultrasound Physician	A Radiology doctor of Osteopathy that specializes in Diagnostic Ultrasound.

Related ICD-10-CM Codes

5 rows

ICD-10-CM Code	Description
J96.10	Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia
J96.11	Chronic respiratory failure with hypoxia
J44.9	Chronic obstructive pulmonary disease, unspecified
G47.33	Obstructive sleep apnea (adult) (pediatric)
R06.02	Shortness of breath

Related Codes

HCPCS-A4206-STERILE-SYRINGE-1CC-NEEDLE

HCPCS A4206: Syringe with Needle, 1 cc or Less, Sterile

HCPCS-A4207-STERILE-2CC-SYRINGE-WITH-NEEDLE

HCPCS Level II A4207: Syringe with Needle, Sterile 2 cc

HCPCS-A4208-STERILE-3CC-SYRINGE-WITH-NEEDLE

HCPCS Level II A4208: Syringe with Needle, Sterile 3 cc

HCPCS-A4209-STERILE-SYRINGE-WITH-NEEDLE-5CC-OR-GREATER

HCPCS Level II A4209: Syringe with Needle, Sterile 5 cc or Greater

HCPCS-A4210-NEEDLE-FREE-INJECTION-DEVICE

HCPCS Level II A4210: Needle-free Injection Device, Each

HCPCS-A4211-SUPPLIES-SELF-ADMINISTERED-INJECTIONS

HCPCS Level II A4211: Supplies for Self-Administered Injections

HCPCS-A4212-NON-CORING-NEEDLE-STYLET-CATHETER-ACCESS-SUPPLY

HCPCS Level II A4212: Non-coring Needle or Stylet with/without Catheter

HCPCS-A4213-STERILE-SYRINGE-20CC-OR-GREATER

HCPCS Level II A4213: Syringe, Sterile, 20 cc or Greater, Each

HCPCS-A4215-STERILE-NEEDLE-SINGLE-EACH

HCPCS Level II A4215: Needle, Sterile, Any Size

HCPCS-A4216-STERILE-DILUENT-FLUSH-10ML

HCPCS Level II A4216: Sterile Diluent/Flush, 10 ml

Showing 1–10 of 633

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

HCPCS Level II A7030: Full Face Mask for Positive Airway Pressure Device

Sign up for hcpcs A7030 policy alerts

National Reimbursement Benchmarks

HCPCS Level II A7030: Full Face Mask for Positive Airway Pressure Device

Sign up for hcpcs A7030 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS code A7030 represent and where is it typically used?

Which diagnoses or clinical situations are associated with billing A7030?

Which modifiers are relevant when billing A7030?

What reimbursement benchmarks and payer variability are shown for A7030?

Are there related interface codes or specialties noted that affect A7030 billing?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS code A7030 represent and where is it typically used?

Which diagnoses or clinical situations are associated with billing A7030?

Which modifiers are relevant when billing A7030?

What reimbursement benchmarks and payer variability are shown for A7030?

Are there related interface codes or specialties noted that affect A7030 billing?

References