MyMedi-AI

A7035 — Headgear used with positive airway pressure device

HCPCS Level II A-code · short descriptor: “Pos airway press headgear”

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
Status
Active (April 2026 HCPCS)

Prior authorization

Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). 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 (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.

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

A7035 Medicare fee schedule (April 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $22.56 to $38.30 depending on state and rural status.

StateNon-ruralRural
AK$36.55
AL$22.89$35.62
AR$22.89$35.41
AZ$22.56$37.23
CA$23.12$37.23
CO$23.37$35.50
CT$24.43$35.75
DC$22.92$37.23
DE$22.92$34.58
FL$22.89$34.12
GA$22.89$34.99
HI$38.20
IA$22.97$37.23
ID$23.37$37.23
IL$23.02$37.23
IN$23.02$37.23
KS$22.97$37.23
KY$22.89$35.20
LA$22.89$36.05
MA$24.43$35.66
MD$22.92$37.23
ME$24.43$36.08
MI$23.02$37.23
MN$22.97$37.23
MO$22.97$37.23
MS$22.89$35.41
MT$23.37$37.23
NC$22.89$34.78
ND$22.97$37.23
NE$22.97$37.23
NH$24.43$34.58
NJ$22.92$34.58
NM$22.56$35.30
NV$23.12$37.23
NY$22.92$34.58
OH$23.02$37.23
OK$22.56$35.25
OR$23.12$37.23
PA$22.92$34.58
PR$38.30
RI$24.43$34.58
SC$22.89$35.20
SD$22.97$37.23
TN$22.89$35.79
TX$22.56$34.12
UT$23.37$37.23
VA$22.89$37.23
VI$34.49
VT$24.43$35.42
WA$23.12$37.23
WI$23.02$37.23
WV$22.89$37.23
WY$23.37$37.23
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026. 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.

Common denial codes to watch

Related A-codes

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