MyMedi-AI

A7029 — Nasal pillows for combination oral/nasal mask, replacement only, pair

HCPCS Level II A-code · short descriptor: “Repl nasal pillow comb mask”

Code system
HCPCS Level II
Family
A — Medical & surgical supplies, ambulance
Medicare coverage status
Carrier judgment — coverage decided by the DME MAC
DMEPOS payment category
Inexpensive or routinely purchased
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required list
MUE unit limit
6
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

A7029 Medicare fee schedule (October 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $18.73 to $27.93 depending on state and rural status.

StateNon-ruralRural
AK$25.06—
AL$19.20$25.11
AR$19.20$25.11
AZ$19.35$25.11
CA$19.35$25.11
CO$18.73$25.11
CT$20.36$25.11
DC$19.21$25.11
DE$19.21$25.11
FL$19.20$25.11
GA$19.20$25.11
HI$25.06—
IA$19.26$25.11
ID$18.73$25.11
IL$19.31$25.11
IN$19.31$25.11
KS$19.26$25.11
KY$19.20$25.11
LA$19.20$25.11
MA$20.36$25.11
MD$19.21$25.11
ME$20.36$25.11
MI$19.31$25.11
MN$19.26$25.11
MO$19.26$25.11
MS$19.20$25.11
MT$18.73$25.11
NC$19.20$25.11
ND$19.26$25.11
NE$19.26$25.11
NH$20.36$25.11
NJ$19.21$25.11
NM$19.35$25.11
NV$19.35$25.11
NY$19.21$25.11
OH$19.31$25.11
OK$19.35$25.11
OR$19.35$25.11
PA$19.21$25.11
PR$27.93—
RI$20.36$25.11
SC$19.20$25.11
SD$19.26$25.11
TN$19.20$25.11
TX$19.35$25.11
UT$18.73$25.11
VA$19.20$25.11
VI$25.06—
VT$20.36$25.11
WA$19.35$25.11
WI$19.31$25.11
WV$19.20$25.11
WY$18.73$25.11
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps A7029 at 6 units per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Published Contractor Policy.

Common denial codes to watch

Related A-codes

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