CPAP Accessories
A7035 HCPCS Code Description and Medicare Billing
A7035 is a HCPCS Level II code for headgear. It describes PAP headgear and has a usual maximum frequency of one per six months under the reviewed PAP policy. Review Medicare coverage, documentation, modifiers, frequency, fee references, policy links, and denial risks.
Quick answer
What is the A7035 code description and frequency?
A7035 is the HCPCS Level II code for PAP or CPAP headgear; it is not a CPT code. The reviewed Medicare PAP policy lists a usual maximum of one A7035 headgear item per six months, but replacement is not automatic and all coverage and refill requirements still apply.
Coverage status
conditional
Documentation required
Yes
F2F/WOPD required list
unknown
Prescription/order
yes
Prior authorization list
unknown
Rental or purchase
supply
Fee schedule
Available
Same/similar risk
Review required
A7035 replacement-frequency answer
The usual Medicare maximum for A7035 is 1 per 6 months under the reviewed PAP policy. This is a maximum replacement frequency, not an automatic refill schedule or guarantee of payment. Before dispensing, document an affirmative refill request, remaining supply, continued reasonable and necessary use, and delivery timing.
Code Summary
Headgear
PAP accessories are conditionally covered when the coverage criteria for the related PAP device are met and the item remains reasonable and necessary.
Before billing, verify medical necessity, order requirements, proof of delivery, supplier eligibility, correct modifiers, frequency limits, and any applicable LCD or policy article.
Official Sources
officialPositive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L33718)
CMS Medicare Coverage Database / Effective 2024-01-01 / Reviewed 2026-08-09
Initial and continued coverage, replacement, accessory frequency, refill, order, and proof-of-delivery requirements.
Positive Airway Pressure (PAP) Devices Policy Article (A52467)
CMS Medicare Coverage Database / Reviewed 2026-08-09
Coding, modifier, documentation, and policy-specific PAP billing instructions.
Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)
CMS Medicare Coverage Database / Reviewed 2026-08-09
General order, medical record, continued need/use, refill, and proof-of-delivery requirements.
July 2026 DMEPOS Fee Schedule (DME26-C)
Centers for Medicare & Medicaid Services / Effective 2026-07-01 / Reviewed 2026-08-09
Official state and rural/non-rural fee schedule amounts and payment category codes.
Is A7035 a CPT code?
No. A7035 is a HCPCS Level II code, although people often search for "A7035 CPT code." CPT is HCPCS Level I and is maintained separately by the American Medical Association. Always verify the code set and payer instructions effective for the date of service.
Reimbursement Status
Coverage is marked conditional. Publication status is verified. This describes the source record, not a claim-specific coverage decision.
Documentation Requirements
Standard written order
A completed SWO must be communicated to the supplier before the claim is submitted.
Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L33718)Proof of delivery
Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.
Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)Affirmative refill request and utilization
Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.
Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L33718)Standard Written Order / Prescription
A standard written order is required before claim submission.
Clinical Evaluation / Conditions of Payment
Verify the related PAP device coverage and any applicable continued-use documentation.
Rental, Purchase, Replacement, or Supply Logic
Payment category: supply. Confirm the base PAP device remains covered and the refill is not duplicative.
A7035 Frequency and Replacement Limits
Usual maximum under LCD L33718: 1 per 6 months. Quantities above the usual maximum require careful policy and medical-necessity review.
The PAP LCD describes usual maximum quantities, not automatic shipment schedules. Document an affirmative refill request, remaining supply, continued need, and delivery timing.
Modifiers
NU New equipment
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
RR Rental
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
UE Used durable medical equipment
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
KX Requirements specified in medical policy have been met
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
GA Waiver of liability statement issued
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
GY Item or service statutorily excluded
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
GZ Item or service expected to be denied
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
RA Replacement of DME item
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
Fee Schedule
DME26-C / Effective 2026-07-01
- Non-rural range across fee rows and states
- $22.56 - $38.30
- Rural range where listed
- $34.12 - $37.23
Fee schedule amounts are payment references and do not prove coverage or guarantee payment.
Common Denials
CARC 16: Missing or Invalid Claim Information
Validate required claim loops, provider roles, identifiers, diagnosis pointers, modifiers, units, charges, and payer-specific companion-guide edits before release.
CARC 18: Duplicate Claim or Service
Lock resubmission while a claim is pending, reconcile clearinghouse and payer claim IDs, and require replacement or void indicators for true corrections.
CARC 22: Coordination of Benefits and Payer Order
Ask current coverage and employment questions, verify payer order for the date of service, and transmit complete primary adjudication data on secondary claims.
CARC 29: Timely Filing Denial
Track deadlines from the service-date rule, reconcile payer receipt rather than only transmission, and escalate unaccepted claims well before expiration.
CARC 97: Service Included in Another Payment
Check code-pair edits, global periods, status indicators, payment packaging, and modifier documentation before submitting separate lines.
CARC 109: Claim Sent to the Wrong Payer or Contractor
Validate plan, network, product, payer ID, contractor jurisdiction, and date-specific routing before submission.
Diagnosis and medical necessity research
These diagnoses are educational research relationships, not a coverage crosswalk or coding recommendation. Open the diagnosis guide and validate the complete clinical record and applicable policy.
Frequently Asked Questions
What is the A7035 code description?
A7035 is the HCPCS Level II code for PAP or CPAP headgear. It is not a CPT code.
How often can Medicare cover A7035 headgear?
The reviewed Medicare PAP policy lists a usual maximum of one A7035 headgear item per six months.
Is A7035 automatically covered every six months?
No. The interval is a usual maximum. The related PAP device, continued need, refill request, order, quantity, timing, and delivery record must support coverage.
Publication and Review Status
Code-level statements have attached official sources. Last reviewed: Aug 9, 2026.