The file's text, extracted by GovTribe without its formatting.
ATTACHMENT F
LIST OF APPROVED PAP DEVICES AND ASSOCIATED ACCESSORIES
The below lists are the approved Positive Airway Pressure (PAP) devices listed in the four (4) Contract Line Items (CLIN) identified within this requirement. Additionally, an approved list for associated Accessories is also identified within these lists of approved products. Every PAP device make and model listed below that is proposed by a vendor will need to have its own sub-CLIN under the appropriate L Code/CLIN identified in Attachment D Price/Cost Schedule. The list below is categorized by the CLIN> HCPCS/L Code>Manufacturer > Model>Part Number.
POSITIVE AIRWAY PRESSURE DEVICES
CLIN 0001: Auto-Titrating Continuous Positive Airway Pressure (APAP) Device HCPCS/L Code: E0601
MANUFACTURER: RESMED
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESMED |
| AirSense 11 Autoset |
| 39000 |
| RESMED |
| AirSense 11 Autoset |
| 39001 |
MANUFACTURER: PHILIPS
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| PHILIPS |
| DREAMSTATION 2 AUTO-CPAP |
| DSX520H11C |
| PHILIPS |
| DREAMSTATION 2 AUTO-CPAP HEATED TUBE |
| DSX520T11C |
CLIN 0002: Adaptive Servo-Ventilation (ASV) HCPCS/L Code E0471 (with backup rate feature)
MANUFACTURER: RESMED
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESMED |
| Aircurve 11 ASV |
| 39012 |
| RESMED |
| AirCurve 11 ASV |
| 39013 |
CLIN 0003A,0003B, 0003C: Bi-level Positive Airway Pressure (BPAP) HCPCS/L Code: E0470 (without backup rate); E0471 (with backup rate feature)
MANUFACTURER: RESMED
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESMED |
| AirCurve 11 VAuto |
| 39018 |
| RESMED |
| AirCurve 11 VAuto |
| 39019 |
CLIN 0004: Volume Assured Pressure Support (VAPS) HCPCS/L Code: E0471 (with backup rate feature)
MANUFACTURER: RESMED
| BRAND |
| MODEL |
| PRODUCT NUMBER |
PAP ACCESSORIES
TUBING
Sub CLIN 0001C, 0001D, 0002C, 0002D, 0003A3, 0003A4, 0003B3, 0003B4, 0003C3, 0003C4, 0004C, 0004D HCPCS/L Code: A7037
MANUFACTURER: RESMED
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESMED |
| SlimLine tubing (for AS11/AC11/DS machines) |
| 37500 |
| RESMED |
| Climateline Air heated tubing (for AS11) |
| 39102 |
| RESMED |
| Climateline Air Oxy tubing (for AS11) |
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| PHILIPS |
| TUBING, CPAP/BIPAP, L 6FT, 12MM |
| 1147466 |
| PHILIPS |
| HEATED TUBING, CPAP/BIPAP, FOR USE WITH DS1 & DS2 |
| HT15 |
| PHILIPS |
| DREAMSTATION MICRO-FLEX 12MM HEATED TUBE |
| HT12 |
FILTERS
Sub CLIN 0001A, 0001B, 0002A, 0002B, 0003A1, 0003A2, 0003B1, 0003B2, 0003C1, 0003C2, 0004A, 0004B HCPCS/L Code: A7038
MANUFACTURER: RESMED
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESMED |
| Filters (2 pack) (for S9 & A10) |
| 36851 |
| RESMED |
| Filters (12 Pack) (for S9 & A10) |
| 36852 |
| RESMED |
| Hypoallergenic filters (12 pack) (for S9 & A10) |
| 36857 |
| RESMED |
| Hypoallergenic filters (2 pack) (for S9 & A10) |
| 36856 |
| RESMED |
| Filters (2 pack) (for A11) |
| 39301 |
| RESMED |
| Filters (12 Pack) (for A11) |
| 39302 |
| RESMED |
| Hypoallergenic filters (12 pack) (for A11) |
| 39305 |
| RESMED |
| Hypoallergenic filters (2 pack) (for A11) |
| 39306 |
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| PHILIPS |
| FILTER, CPAP, USE WITH DS1, ULTRA FINE, DISP, 1 ¼ X 1 ¾ inch 2PK |
| 1122518 |
| PHILIPS |
| FILTER, CPAP, USE WITH DS1, ULTRA FINE, DISP, 1 ¼ X 1 ¾ inch 6PK |
| 1122519 |
| PHILIPS |
| FILTER, CPAP, USE WITH DS1, REUSABLE, 3/8 X 1 ¾ X 1 inch, POLLEN 1PK |
| 1122446 |
| PHILIPS |
| DreamStation 2 Reusable Filter (1pk) |
| 1142687 |
| PHILIPS |
| DreamStation 2 Disposable, Ultrafine Filter 2 pk |
| 1142829 |
| PHILIPS |
| DreamStation 2 Disposable, Ultrafine Filter 6 pk |
| 1142831 |
CHAMBERS
Sub CLIN 0001E, 0002E, 0003A5, 0003B5, 0003C5, 0004E HCPCS/L Code: A7046 water chamber for humidifier - replacement
MANUFACTURER: RESMED
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESMED |
| Standard Water Chamber for AirSense™ 10, and AirCurve™ 10 Humidair™ Heated Humidifier |
| 37299 |
| RESMED |
| Humidair Heated Standard Tub, AirSense 11/Aircurve 11 |
| 39202 |
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| PHILIPS |
| Water Chamber for DreamStation Heated Humidifier |
| 1122520 |
| PHILIPS |
| DreamStation 2 Water tank no lid |
| 1146072 |
| PHILIPS |
| DreamStation 2 Water tank with lid |
| 1142832 |
| PHILIPS |
| DreamStation 2 Water tank lid only |
| 1146073 |
OTHER ACCESSORIES
Sub CLIN 0001F, 0001G, 0001H, 0002F, 0002G, 0002H, 0003A6, 0003A7, 0003A8, 0003B6, 0003B7, 0003B8, 0003C6, 0003C7, 0003C8, 0004F, 0004G, 0004H
HCPCS/L Code: E1399 (A10 Power Pack) A9279 (SD Card 10 pack with folder)
MANUFACTURER: RESMED
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESMED |
| Power pack (A10) |
| 37344 |
| RESMED |
| Card with folder (10 pack) |
| 37329 |
| RESMED |
| ResMed AC Power Supply (with Cord) for AirSense 11 Series CPAP Machines |
| 39205 |
| RESMED |
| SD Card 1pk Airsense 11/Aircurve 11 |
| 39228 |
| RESMED |
| SD Card 10pk Airsense 11/Aircurve 11 |
| 39228 |
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| PHILIPS |
| DreamStation 80-Watt Power Supply |
| 1144267 |
| PHILIPS |
| M-AND-60 Series Power Cord 6ft |
| 1005894 |
CLIN 0005: FULL FACE MASKS-COMPLETE SYSTEMS
HCPCS/L Code: A7030
MANUFACTURER: RESMED
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESMED |
| AIRFIT-F20-FFM-4HER-M |
| 63404 |
| RESMED |
| AIRFIT-F20-FFM-4HER-S |
| 63403 |
| RESMED |
| AIRFIT-F20-LARGE |
| 63402 |
| RESMED |
| AIRFIT-F20-MEDIUM |
| 63401 |
| RESMED |
| AIRFIT-F20-SMALL |
| 63400 |
| RESMED |
| AIRFIT-F20-STARTER-PACK |
| 63450 |
| RESMED |
| AIRFITF30-COMPLETE-SYSTEM-M |
| 64101 |
| RESMED |
| AIRFITF30-COMPLETE-SYSTEM-S |
| 64100 |
| RESMED |
| AIRFIT F30I CMPLT SYS M/L- |
| 63334 |
| RESMED |
| AIRFIT F30I CMPLT SYS WIDE- |
| 63333 |
| RESMED |
| AIRFIT F30I CMPLT SYS WIDE- |
| 63333 |
| RESMED |
| AIRFIT F30I COMPLETE SYS S/SM |
| 63330 |
| RESMED |
| AIRFIT F30I COMPLTE SYS MED |
| 63332 |
| RESMED |
| AIRFIT F30I MASK STARTER PK |
| 63301 |
| RESMED |
| AIRFIT F30I SM STARTER PACK- |
| 63300 |
| RESMED |
| AIRFIT F40 COMPLETE SYS SMALL/WIDE |
| 64600 |
| RESMED |
| AIRFIT F40 COMPLETE SYS MED |
| 64601 |
| RESMED |
| AIRFIT F40 COMPLETE SYS LARGE |
| 64602 |
| RESMED |
| AIRTOUCH-F20-FFM-4HER-M |
| 63004 |
| RESMED |
| AIRTOUCH-F20-FFM-4HER-S |
| 63003 |
| RESMED |
| AIRTOUCHF20-LARGE |
| 63002 |
| RESMED |
| AIRTOUCHF20-MEDIUM |
| 63001 |
| RESMED |
| AIRTOUCHF20-SMALL |
| 63000 |
| RESMED |
| MIRAGE-QUATTRO-FFM-LARGE |
| 61203 |
| RESMED |
| MIRAGE-QUATTRO-FFM-MEDIUM |
| 61202 |
| RESMED |
| MIRAGE-QUATTRO-FFM-SMALL |
| 61201 |
| RESMED |
| MIRAGE-QUATTRO-FFM-XS |
| 61200 |
| RESMED |
| MIRAGE-QUATTRO-FX-FFM-4HER-M |
| 62502 |
| RESMED |
| MIRAGE-QUATTRO-FX-FFM-4HER-S |
| 62501 |
| RESMED |
| MIRAGE-QUATTRO-FX-LARGE |
| 61702 |
| RESMED |
| MIRAGE-QUATTRO-FX-SMALL |
| 61700 |
| RESMED |
| MIRAGE-QUATTRO-FFM-LARGE |
| 61203 |
| RESMED |
| MIRAGE-QUATTRO-FFM-MEDIUM |
| 61202 |
| RESMED |
| QUATTROAIR-FOR-HER-MEDIUM |
| 62742 |
| RESMED |
| QUATTROAIR-FOR-HER-SMALL |
| 62741 |
| RESMED |
| QUATTROAIR-FOR-HER-XS |
| 62740 |
| RESMED |
| QUATTROAIR-LARGE |
| 62703 |
| RESMED |
| QUATTROAIR-MEDIUM |
| 62702 |
| RESMED |
| QUATTROAIR-SMALL |
| 62701 |
MANUFACTURER: FISHER PAYKEL
| FISHER BRAND |
| MODEL |
| PRODUCT NUMBER |
| FISHER PAYKEL |
| EVORA FULL MASK FITPACK FN |
| EVF1XMLA |
| FISHER PAYKEL |
| EVORA FULL MASK-EXTRA SMALL |
| EVF1XA |
| FISHER PAYKEL |
| EVORA FULL MASK-LARGE A MODEL |
| EVF1LA |
| FISHER PAYKEL |
| EVORA FULL MASK-SM/MED A MODEL |
| EVF1MA |
| FISHER PAYKEL |
| FORMA-FFM-MEDIUM-LARGE |
| 400471A |
| FISHER PAYKEL |
| FORMA-FFM-SMALL |
| 400470A |
| FISHER PAYKEL |
| FORMA-FFM-XLARGE |
| 400473A |
| FISHER PAYKEL |
| SIMPLUS-FFM-FITPK-SEAL-S/M/L |
| 400483 |
| FISHER PAYKEL |
| SIMPLUS-FFM-FITPK-SEAL-S/M/L |
| 400483 |
| FISHER PAYKEL |
| SIMPLUS-FFM-L-1-EXTRA-CUSHN-L |
| 400481 |
| FISHER PAYKEL |
| SIMPLUS-FFM-LARGE |
| 400477 |
| FISHER PAYKEL |
| SIMPLUS-FFM-M-1-EXTRA-CUSHN-M |
| 400480 |
| FISHER PAYKEL |
| SIMPLUS-FFM-MEDIUM |
| 400476 |
| FISHER PAYKEL |
| SIMPLUS-FFM-S-1-EXTRA-CUSHN-S |
| 400479 |
| FISHER PAYKEL |
| SIMPLUS-FFM-SMALL |
| 400475 |
| FISHER PAYKEL |
| SIMPLUS-FFM-FITPK-SEAL-S/M/L |
| 400483 |
| FISHER PAYKEL |
| VITERA-FFM-LARGE |
| VIT1LA |
| FISHER PAYKEL |
| VITERA-FFM-MEDIUM |
| VIT1MA |
| FISHER PAYKEL |
| VITERA-FFM-S/M/L |
| VIT1SMLA |
| FISHER PAYKEL |
| VITERA-FFM-SMALL |
| VIT1SA |
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESPIRONICS |
| AMARA-GEL-REDUCED-FRAME/HG-P |
| 1090400 |
| RESPIRONICS |
| AMARA-GEL-REDUCED-FRAME/HG-S |
| 1090401 |
| RESPIRONICS |
| AMARA-GEL-REDUCED-FRM-STD/HG-L |
| 1090406 |
| RESPIRONICS |
| AMARA-GEL-REDUCED-FRM-STD/HG-M |
| 1090405 |
| RESPIRONICS |
| AMARA-SIL-REDUCED-FRAME-HG-L |
| 1090227 |
| RESPIRONICS |
| AMARA-SIL-REDUCED-FRAME/HG-M |
| 1090226 |
| RESPIRONICS |
| AMARA-VIEW-FITPACK-CUSHN-S/M/L |
| 1090670 |
| RESPIRONICS |
| AMARA-VIEW-MINIMAL-CONTACT-L |
| 1090624 |
| RESPIRONICS |
| AMARA-VIEW-MINIMAL-CONTACT-M |
| 1090623 |
| RESPIRONICS |
| AMARA-VIEW-MINIMAL-CONTACT-S |
| 1090622 |
| RESPIRONICS |
| DREAMWEAR-FFM-FITPACK-M-FRAME |
| 1143130 |
| RESPIRONICS |
| DREAMWEAR-FFM-L-CUSHN-L-FRM |
| 1133392 |
| RESPIRONICS |
| DREAMWEAR-FFM-L-CUSHN-M-FRM |
| 1133382 |
| RESPIRONICS |
| DREAMWEAR-FFM-L-CUSHN-S-FRM |
| 1133387 |
| RESPIRONICS |
| DREAMWEAR-FFM-L-CUSHN-S/M-FRM |
| 1133377 |
| RESPIRONICS |
| DREAMWEAR-FFM-M-CUSHN-L-FRM |
| 1133391 |
| RESPIRONICS |
| DREAMWEAR-FFM-M-CUSHN-M-FRM |
| 1133381 |
| RESPIRONICS |
| DREAMWEAR-FFM-M-CUSHN-S-FRM |
| 1133386 |
| RESPIRONICS |
| DREAMWEAR-FFM-M-CUSHN-S/M-FRM |
| 1133376 |
| RESPIRONICS |
| DREAMWEAR-FFM-M-WD-CUSHN-L-FRM |
| 1133393 |
| RESPIRONICS |
| DREAMWEAR-FFM-M-WD-CUSHN-M-FRM |
| 1133383 |
| RESPIRONICS |
| DREAMWEAR-FFM-M-WD-CUSHN-S-FRM |
| 1133388 |
| RESPIRONICS |
| DREAMWEAR-FFM-S-CUSHN-L-FRM |
| 1133390 |
| RESPIRONICS |
| DREAMWEAR-FFM-S-CUSHN-M-FRM |
| 1133380 |
| RESPIRONICS |
| DREAMWEAR-FFM-S-CUSHN-S-FRM |
| 1133385 |
| RESPIRONICS |
| DREAMWEAR-FFM-S-CUSHN-S/M-FRM |
| 1133375 |
| RESPIRONICS |
| FITLIFE-TOTAL-FACE-L |
| 1060802 |
| RESPIRONICS |
| FITLIFE-TOTAL-FACE-S |
| 1060801 |
| RESPIRONICS |
| FLEXIFIT431-FFM-S/M/L |
| HC431A |
CLIN 0006: NASAL MASKS-COMPLETE SYSTEM
HCPCS/L Code: A7034
MANUFACTURER: RESMED
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESMED |
| AIRFIT-N20-STARTER-PACK MP |
| 63535 |
| RESMED |
| AIRFITN20-4HER-NASAL-SMALL |
| 63500 |
| RESMED |
| AIRFITN20-NASAL-MASK/HG-LARGE |
| 63502 |
| RESMED |
| AIRFITN20-NASAL-MASK/HG-MEDIUM |
| 63501 |
| RESMED |
| AIRFITN20-NASAL-MASK/HG-SMALL |
| 63503 |
| RESMED |
| AIRFIT-N30-NSL-CRADLE-MEDIUM |
| 64223 |
| RESMED |
| AIRFIT-N30-NSL-CRADLE-SMALL |
| 64222 |
| RESMED |
| AIRFIT-N30-SMALL-WIDE |
| 64224 |
| RESMED |
| AIRFIT-N30I-SMALL |
| 63801 |
| RESMED |
| AIRFIT-N30I-STANDARD |
| 63800 |
| RESMED |
| AIRTOUCH N20 NASAL MASK-LG MP |
| 63902 |
| RESMED |
| AIRTOUCH N20 NASAL MASK-MD FN |
| 63901 |
| RESMED |
| AIRTOUCH N20 NASAL MASK-MD MP |
| 63901 |
| RESMED |
| AIRTOUCH N20 NASAL MASK-SMALL |
| 63903 |
| RESMED |
| AIRTOUCH N20 4-HER NASAL MASK |
| 63900 |
| RESMED |
| MIRAGE-FX-NASAL-4HER-PINK-S |
| 62109 |
| RESMED |
| MIRAGE-FX-NASAL-4HER-PINK-STD |
| 62128 |
| RESMED |
| MIRAGE-FX-NASAL-GREY-STD |
| 62103 |
| RESMED |
| MIRAGE-FX-NASAL-GREY-WD |
| 62118 |
| RESMED |
| SWIFT-FX-BELLA-NSL-PLWSYS-GRAY |
| 61568 |
| RESMED |
| SWIFT-FX-BELLA-NSL-PLWSYS-PINK |
| 61560 |
| RESMED |
| SWIFT-FX-FOR-HER-XS/S/M |
| 61540 |
| RESMED |
| SWIFT-FX-NASAL-PILLOW-S/M/L |
| 61500 |
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESPIRONICS |
| DREAMWISP-NASAL-M-CONNECTOR-L |
| 1137935 |
| RESPIRONICS |
| DREAMWISP-NASAL-M-CONNECTOR-M |
| 1137934 |
| RESPIRONICS |
| DREAMWISP-NASAL-M-CONNECTOR-P |
| 1137932 |
| RESPIRONICS |
| DREAMWISP-NASAL-M-CONNECTOR-S |
| 1137933 |
| RESPIRONICS |
| DREAMWISP-NASAL-M-CONNECTOR-XL |
| 1137936 |
| RESPIRONICS |
| DREAMWR-NSL-L-FRAME-L-CUSHION |
| 1116692 |
| RESPIRONICS |
| DREAMWR-NSL-L-FRAME-M-CUSHION |
| 1116691 |
| RESPIRONICS |
| DREAMWR-NSL-L-FRAME-M-WD-CUSHN |
| 1116693 |
| RESPIRONICS |
| DREAMWR-NSL-L-FRAME-S-CUSHION |
| 1116690 |
| RESPIRONICS |
| DREAMWR-NSL-M-FRAME-L-CUSHION |
| 1116682 |
| RESPIRONICS |
| DREAMWR-NSL-M-FRAME-M-CUSHION |
| 1116681 |
| RESPIRONICS |
| DREAMWR-NSL-M-FRAME-M-WD-CUSHN |
| 1116683 |
| RESPIRONICS |
| DREAMWR-NSL-S-FRAME-L-CUSHION |
| 1116687 |
| RESPIRONICS |
| DREAMWR-NSL-S-FRAME-M-CUSHION |
| 1116686 |
| RESPIRONICS |
| DREAMWR-NSL-S-FRAME-M-WD-CUSHN |
| 1116688 |
| RESPIRONICS |
| DREAMWR-NSL-S-FRAME-S-CUSHION |
| 1116685 |
| RESPIRONICS |
| DREAMWSP-NSL-FITPAK-M-CNECT |
| 1137916 |
| RESPIRONICS |
| FLEXIFIT-NASAL-CUSHION-S/L |
| HC405A |
| RESPIRONICS |
| FLEXIFIT-NASAL-CUSHION-STD-L |
| HC407A |
| RESPIRONICS |
| FLEXIFIT-NASAL-PETITE |
| HC406A |
| RESPIRONICS |
| WISP-NSL-CLEAR-FRAME-MAG-CLIP |
| 1094050 |
| RESPIRONICS |
| WISP-NSL-FITPAK-FABRIC-FRAME-P |
| 1094053 |
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| FISHER PAYKEL |
| ESON-NASAL-LARGE |
| 400451 |
| FISHER PAYKEL |
| ESON-NASAL-MEDIUM |
| 400450 |
| FISHER PAYKEL |
| ESON-NASAL-SMALL |
| 400449 |
| FISHER PAYKEL |
| ESON 2 NASAL LARGE |
| ESN2LA |
| FISHER PAYKEL |
| ESON 2 NASAL MEDIUM |
| ESN2MA |
| FISHER PAYKEL |
| ESON 2 NASAL SMALL |
| ESN2SA |
| FISHER PAYKEL |
| ESON 2 NASAL FITPACK S/M/L |
| ESN2SML |
| FISHER PAYKEL |
| EVORA NASAL MASKFITPACK |
| EVO1SMLA |
| FISHER PAYKEL |
| EVORA NASAL MASK LG |
| EVO1LA |
| FISHER PAYKEL |
| EVORA NASAL MASK MD |
| EVO1MA |
| FISHER PAYKEL |
| EVORA NASAL MASK SM |
| EVO1SA |
| FISHER PAYKEL |
| EVORA NASAL MASK WIDE |
| EVO1WA |
| FISHER PAYKEL |
| F&P SOLO NASAL MASK FITPACK |
| SLN1SMLA |
| FISHER PAYKEL |
| F&P SOLO HEADGEAR, SELF ADJUSTING |
| 400SL122 |
| FISHER PAYKEL |
| ZEST-NASAL-PLUS-LARGE |
| 400441A |
| FISHER PAYKEL |
| ZEST-NASAL-SMALL/PETITE |
| 400439A |
| FISHER PAYKEL |
| ZEST-NASAL-STANDARD-MEDIUM |
| 400440A |
| FISHER PAYKEL |
| ZEST-Q-NASAL-PETITE |
| 400444A |
| FISHER PAYKEL |
| ZEST-Q-NASAL-PLUS |
| 400446A |
| FISHER PAYKEL |
| ZEST-Q-NASAL-STANDARD |
| 400445A |
CLIN 0007: NASAL PILLOWS MASK
HCPCS/L Code: A7034
PRODUCT DESCRIPTION: NASAL PILLOWS
MANUFACTURER: RESMED
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESMED |
| AIRFIT-P10-FOR-HER-XS/S/M |
| 62910 |
| RESMED |
| AIRFITP30I-NSL-PLW-S-FRM-S/M |
| 63851 |
| RESMED |
| AIRFITP30I-NSL-PLW-STD-FRM-S/M |
| 63850 |
| RESMED |
| SWIFT-FX-BELLA-NSL-PLWSYS-GRAY |
| 61568 |
| RESMED |
| SWIFT-FX-BELLA-NSL-PLWSYS-PINK |
| 61560 |
| RESMED |
| SWIFT-FX-FOR-HER-XS/S/M |
| 61540 |
| RESMED |
| SWIFT-FX-NASAL-PILLOW-S/M/L |
| 61500 |
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESPIRONICS |
| DREAMWR-SIL-PILLOW-CUSHN-M |
| 1146473 |
| RESPIRONICS |
| DREAMWR-SIL-PLW-FITPAK-M-FRM |
| 1146468 |
| RESPIRONICS |
| DREAMWR-SIL-PLW-L-CUSHN-M-FRM |
| 1146416 |
| RESPIRONICS |
| DREAMWR-SIL-PLW-M-CUSHN-M-FRM |
| 1146415 |
| RESPIRONICS |
| DREAMWR-SIL-PLW-S-CUSHN-M-FRM |
| 1146414 |
| BRAND |
| MODEL | |
| PRODUCT NUMBER | |
| FISHER PAYKEL |
| BREVIDA-NSL-PLW-M-SEALS-M/L |
| BRE1MA |
| FISHER PAYKEL |
| BREVIDA-NSL-PLW-S-SEALS-XS/S |
| BRE1SA |
| FISHER PAYKEL |
| BRVIDA-NSL-PLW-S-SEAL-XS/S-M/L |
| BRE1SMA |
| FISHER PAYKEL |
| OPUS-360-NSL-PLW-S/M/L |
| HC482A |
| FISHER PAYKEL |
| PILAIRO-Q-NASAL-PILLOW-SYSTEM |
| 400421 |
| FISHER PAYKEL |
| F&P SOLO NASAL PILLOW MASK FITPACK |
| SLP1SMLA |
CLIN 0008: MASK LINERS
HCPCS/L Code: E1399
MANUFACTURER: NATURS DESIGN
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| NATURS DESIGN |
| REMZS-ACT-MCR-RES-WD-NSL-30PK |
| K11-NM |
| NATURS DESIGN |
| REMZS-ACT-MICRO-RES-L-30PK |
| K12-NL |
| NATURS DESIGN |
| REMZS-ACT-MICRO-RES-NSL-S-30PK |
| K10-NS |
| NATURS DESIGN |
| REMZS-ARFT-QUATRO-ULTRA-L-30PK |
| K3-FL |
| NATURS DESIGN |
| REMZS-ARFT-QUATRO-ULTRA-M-30PK |
| K2-FM |
| NATURS DESIGN |
| REMZS-ARFT-QUATRO-ULTRA-S-30PK |
| K1-FS |
| NATURS DESIGN |
| REMZS-CMF-CLSIC-PRO-NSL-L-30PK |
| K9-NL |
| NATURS DESIGN |
| REMZS-CMF-CLSIC-PRO-NSL-M-30PK |
| K8-NM |
| NATURS DESIGN |
| REMZS-CMF-CLSIC-SLT-NSL-S-30PK |
| K7-NS |
| NATURS DESIGN |
| REMZS-DREAMWEAR-ALLSIZE-30PK |
| 6C-AVK |
| NATURS DESIGN |
| REMZS-FITLIFE-ALLSIZE-30PK |
| 6A-FLK |
| NATURS DESIGN |
| REMZS-FITLIFE-XL-30PK |
| 6B-FLK |
| NATURS DESIGN |
| REMZS-FLEXIFIT-FORMA-L-30PK |
| K6-FL |
| NATURS DESIGN |
| REMZS-FLEXIFIT-FORMA-M-30PK |
| K5-FM |
| NATURS DESIGN |
| REMZS-FLEXIFIT-FORMA-S-30PK |
| K4-FS |
| NATURS DESIGN |
| REMZS-QUATTRO-ULTRA-CMF-L-6PK |
| S3-FL |
| NATURS DESIGN |
| REMZS-QUATTRO-ULTRA-CMF-M-6PK |
| S2-FM |
| NATURS DESIGN |
| REMZS-QUATTRO-ULTRA-CMF-S-6PK |
| S1-FS |
| NATURS DESIGN |
| REMZS-RES-RESP-FP-NSL-PLW-30PK |
| 7A-NPK |
| NATURS DESIGN |
| REMZS-RESP/RES/FP-NSL-P-30PK |
| 10A-NXK |
MANUFACTURER: SILENT NIGHT HEALTH
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| SILENT NIGHT |
| SILENTNIGHT-FITLIFE -L/XL-4PK |
| T103 |
| SILENT NIGHT |
| SILENTNIGHT-FITLIFE-S-4PK |
| T101 |
| SILENT NIGHT |
| SILENTNIGHT-NASAL-1SIZE-4PK |
| N500 |
| SILENT NIGHT |
| SILENTNT-FULLFACE-1SIZE-4PK |
| V200 |
| SILENT NIGHT |
| SILENTNT-FULLFACE-LARGE-4PK |
| F103 |
| SILENT NIGHT |
| SILENTNT-FULLFACE-MEDIUM-4PK |
| F102 |
| SILENT NIGHT |
| SILENTNT-FULLFACE-SMALL-4PK |
| F101 |
MANUFACTURER: SNUGZ
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| SNUGZ |
| SNUGS-FFM-LINERS-WHITE/2PK |
| SFFML |
| SNUGZ |
| SNUGS-NSL-MASK-LINER-WHITE/2PK |
| SN1000 |
CLIN 0008: CHIN STRAPS
HCPCS/L Code: A7036
MANUFACTURER: TIARA
| TIARA |
| TOPAZ ADJUSTABLE CHIN STRAP-L |
| TMS-09ADJ |
| TIARA |
| TOPAZ ADJUSTABLE CHIN STRAP-XL |
| TMS-09ADJXL |
MANUFACTURER: RESMED
| RESMED |
| ADJUSTABLE CLOTH ELASTIC CHIN STRAP |
| 16015 |
MANUFACTURER: RESPIRONICS
| RESPIRONICS |
| CHIN STRAP DELUXE WHITE WIDE |
| 302425 |
| RESPIRONICS |
| CHIN STRAP PREMIUM BLACK |
| 1012911 |
Sub CLIN 0005A: FULL FACE MASK CUSHIONS HCPCS/L Code: A7031
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESMED |
| AIRFIT-F20-CUSHION-LARGE |
| 63469 |
| RESMED |
| AIRFIT-F20-CUSHION-MEDIUM |
| 63468 |
| RESMED |
| AIRFIT-F20-CUSHION-SMALL |
| 63467 |
| RESMED |
| AIRFIT30-CUSHION-MEDIUM |
| 64151 |
| RESMED |
| AIRFIT30-CUSHION-SMALL |
| 64150 |
| RESMED |
| AIRFIT-F30I-CUSHION SML-WIDE |
| 63352 |
| RESMED |
| AIRFIT-F30I-CUSHION-MEDIUM |
| 63351 |
| RESMED |
| AIRFIT-F30I-CUSHION-SM-FN |
| 63350 |
| RESMED |
| AIRFIT-F30I-CUSHION-WIDE |
| 63353 |
| RESMED |
| AIRFIT-F40-CUSHION-SMALL/WIDE |
| 64627 |
| RESMED |
| AIRFIT-F40-CUSHION-MED |
| 64628 |
| RESMED |
| AIRFIT-F40-CUSHION-LRG |
| 64629 |
| RESMED |
| AIRTOUCH-F20-CUSHION-LARGE |
| 63030 |
| RESMED |
| AIRTOUCH-F20-CUSHION-MEDIUM |
| 63029 |
| RESMED |
| AIRTOUCH-F20-CUSHION-SMALL |
| 63028 |
| RESMED |
| MIRAGE-QUATTRO-CUSHION-L |
| 61293 |
| RESMED |
| MIRAGE-QUATTRO-CUSHION-M |
| 61292 |
| RESMED |
| MIRAGE-QUATTRO-CUSHION-S |
| 61291 |
| RESMED |
| MIRAGE-QUATTRO-CUSHION-XS |
| 61290 |
| RESMED |
| QUATTRO-FX-FX-4HER-CUSHION-L |
| 61723 |
| RESMED |
| QUATTRO-FX-FX-4HER-CUSHION-M |
| 61722 |
| RESMED |
| QUATTRO-FX-FX-4HER-CUSHION-S |
| 61721 |
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESPIRONICS |
| AMARA FULL-F REPLC CUSH LG -FN |
| 1090294 |
| RESPIRONICS |
| AMARA FULL-F REPLC CUSH MD -FN |
| 1090293 |
| RESPIRONICS |
| AMARA FULL-F REPLC CUSH SM -FN |
| 1090292 |
| RESPIRONICS |
| AMARA-VIEW-CUSHION-LARGE |
| 1090694 |
| RESPIRONICS |
| AMARA-VIEW-CUSHION-MEDIUM |
| 1090693 |
| RESPIRONICS |
| AMARA-VIEW-CUSHION-SMALL |
| 1090692 |
| RESPIRONICS |
| DREAMWEAR-FFM-CUSHION-LARGE |
| 1133432 |
| RESPIRONICS |
| DREAMWEAR-FFM-CUSHION-MEDIUM |
| 1133431 |
| RESPIRONICS |
| DREAMWEAR-FFM-CUSHION-SMALL |
| 1133430 |
| RESPIRONICS |
| DREAMWEAR-FFM-CUSHION-WIDE-M |
| 1133433 |
| RESPIRONICS |
| FLEXIFIT-HC432-FOAM-SEAL-SET-L |
| 400HC115 |
| RESPIRONICS |
| FLEXIFIT-HC432-FOAM-SEAL-SET-M |
| 400HC114 |
| RESPIRONICS |
| FLEXIFIT-HC432-FOAM-SEAL-SET-S |
| 400HC113 |
| RESPIRONICS |
| FLEXIFIT-HC432-FOAM-SEAL-SETXL |
| 400HC119 |
| RESPIRONICS |
| FLEXIFIT-SEAL-LARGE |
| 400HC103 |
| RESPIRONICS |
| FLEXIFIT-SEAL-MEDIUM |
| 400HC104 |
| RESPIRONICS |
| FLEXIFIT-SEAL-SMALL |
| 400HC112 |
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| FISHER PAYKEL |
| COMFORTGEL-BLUE-CUSHION-FLAP-L |
| 1070105 |
| FISHER PAYKEL |
| COMFORTGEL-BLUE-CUSHION-FLAP-M |
| 1070106 |
| FISHER PAYKEL |
| COMFORTGEL-BLUE-CUSHION-FLAP-S |
| 1070107 |
| FISHER PAYKEL |
| EVORA FULL SEAL-EXTRA SMALL |
| 400EVF114 |
| FISHER PAYKEL |
| EVORA FULL SEAL-LARGE |
| 400EVF116 |
| FISHER PAYKEL |
| EVORA FULL SEAL-SMALL/MEDIUM |
| 400EVF115 |
| FISHER PAYKEL |
| FORMA-FFM-SEAL-FOAM-CUSHN-L |
| 400HC123 |
| FISHER PAYKEL |
| FORMA-FFM-SEAL-FOAM-CUSHN-M |
| 400HC122 |
| FISHER PAYKEL |
| FORMA-FFM-SEAL-FOAM-CUSHN-S |
| 400HC121 |
| FISHER PAYKEL |
| FORMA-FFM-SEAL-FOAM-CUSHN-XL |
| 400HC124 |
| FISHER PAYKEL |
| SIMPLUS-SEAL-FFM-LARGE |
| 400HC581 |
| FISHER PAYKEL |
| SIMPLUS-SEAL-FFM-MEDIUM |
| 400HC580 |
| FISHER PAYKEL |
| SIMPLUS-SEAL-FFM-SMALL |
| 400HC579 |
| FISHER PAYKEL |
| VITERA-SEAL-LARGE |
| 400VIT116 |
| FISHER PAYKEL |
| VITERA-SEAL-MEDIUM |
| 400VIT115 |
| FISHER PAYKEL |
| VITERA-SEAL-SMALL |
| 400VIT114 |
Sub CLIN 0006A: NASAL MASK CUSHIONS HCPCS/L Code: A7032
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESMED |
| AIRFIT-N20-CUSHION-LARGE |
| 63552 |
| RESMED |
| AIRFIT-N20-CUSHION-MEDIUM |
| 63551 |
| RESMED |
| AIRFIT-N20-CUSHION-SMALL |
| 63550 |
| RESMED |
| AIRFIT-N30-CUSHION-MEDIUM |
| 64214 |
| RESMED |
| AIRFIT-N30-CUSHION-SMALL |
| 64213 |
| RESMED |
| AIRFIT-N30-CUSHION-WIDE-SMALL |
| 64215 |
| RESMED |
| AIRFIT-N30I-CUSHION-MEDIUM |
| 63811 |
| RESMED |
| AIRFIT-N30I-CUSHION-SMALL |
| 63813 |
| RESMED |
| AIRFIT-N30I-CUSHION-SMALL-WIDE |
| 63810 |
| RESMED |
| AIRFIT-N30I-CUSHION-WIDE |
| 63812 |
| RESMED |
| AIRTOUCH N20 CUSHION-LARGE |
| 63952 |
| RESMED |
| AIRTOUCH N20 CUSHION-MEDIUM |
| 63951 |
| RESMED |
| AIRTOUCH N20 CUSHION-SMALL |
| 63950 |
| RESMED |
| MIRAGE-FX-CUSHION-FORHER |
| 62136 |
| RESMED |
| MIRAGE-FX-CUSHION-STANDARD |
| 62111 |
| RESMED |
| MIRAGE-FX-CUSHION-WIDE |
| 62125 |
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESPIRONICS |
| DREAMWEAR-NASAL-CUSHION-LARGE |
| 1116742 |
| RESPIRONICS |
| DREAMWEAR-NASAL-CUSHION-MEDIUM |
| 1116741 |
| RESPIRONICS |
| DREAMWEAR-NASAL-CUSHION-SMALL |
| 1116740 |
| RESPIRONICS |
| DREAMWISP-CUSHION-LARGE |
| 1137959 |
| RESPIRONICS |
| DREAMWR-NSL-CUSHION-WIDE-M |
| 1116743 |
| RESPIRONICS |
| DREAMWISP-CUSHION-MEDIUM |
| 1137958 |
| RESPIRONICS |
| DREAMWISP-CUSHION-PETITE |
| 1137956 |
| RESPIRONICS |
| DREAMWISP-CUSHION-SMALL |
| 1137957 |
| RESPIRONICS |
| FLEXIFT-HC406-SIL-SEAL-FOMKIT |
| 400HC509 |
| RESPIRONICS |
| FLEXIFT-HC407-SIL-SEAL-FOMKIT |
| 400HC501 |
| RESPIRONICS |
| FLEXIFT405-SIL-SEAL-FOAMKIT-L |
| 900HC428 |
| RESPIRONICS |
| FLEXIFT405-SIL-SEAL-FOAMKIT-S |
| 900HC427 |
| RESPIRONICS |
| WISP-CUSHION-EXTRA-LARGE |
| 1112031 |
| RESPIRONICS |
| WISP-CUSHION-LARGE |
| 1094088 |
| RESPIRONICS |
| WISP-CUSHION-PETITE |
| 1094086 |
| RESPIRONICS |
| WISP-CUSHION-SMALL/MEDIUM |
| 1094087 |
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| FISHER PAYKEL |
| ESON-SEAL-LARGE |
| 400HC128 |
| FISHER PAYKEL |
| ESON-SEAL-SMALL |
| 400HC126 |
| FISHER PAYKEL |
| ESON-2-NASAL-SEAL-LARGE |
| 400ESN216 |
| FISHER PAYKEL |
| ESON-2-NASAL-SEAL-MEDIUM |
| 400ESN215 |
| FISHER PAYKEL |
| ESON-2-NASAL-SEAL-SMALL |
| 400ESN214 |
| FISHER PAYKEL |
| OPUS-360-NSL-PLW-SIL-SEAL-L |
| 400HC118 |
| FISHER PAYKEL |
| OPUS-360-NSL-PLW-SIL-SEAL-M |
| 400HC117 |
| FISHER PAYKEL |
| OPUS-360-NSL-PLW-SIL-SEAL-S |
| 400HC116 |
| FISHER PAYKEL |
| F&P Solo Nasal CPAP Mask - Repl Cushion-S |
| 400SLN115 |
| FISHER PAYKEL |
| F&P Solo Nasal CPAP Mask - Repl Cushion-M |
| 400SLN116 |
| FISHER PAYKEL |
| F&P Solo Nasal CPAP Mask - Repl Cushion-L |
| 400SLN117 |
| FISHER PAYKEL |
| F&P Solo Nasal CPAP Mask - Repl Cushion-W |
| 400SLN118 |
| FISHER PAYKEL |
| ZEST-FOAM-CUSHN-SIL-SEAL-L |
| 400HC558 |
| FISHER PAYKEL |
| ZEST-FOAM-CUSHN-SIL-SEAL-P |
| 400HC557 |
| FISHER PAYKEL |
| ZEST-FOAM-CUSHN-SIL-SEAL-STD-M |
| 400HC542 |
Sub CLIN 0007A: NASAL PILLOWS HCPCS/L Code: A7033
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| RESMED |
| AIRFIT-P10-4HER-PLW-CUSHN-L |
| 62933 |
| RESMED |
| AIRFIT-P10-4HER-PLW-CUSHN-M |
| 62932 |
| RESMED |
| AIRFIT-P10-4HER-PLW-CUSHN-S |
| 62931 |
| RESMED |
| AIRFIT-P10-4HER-PLW-CUSHN-XS |
| 62930 |
| RESMED |
| AIRFITP30I-PILLOW-CUSHION-M |
| 63862 |
| RESMED |
| AIRFITP30I-PILLOW-CUSHION-S |
| 63861 |
| RESMED |
| SWIFT-FX-BELLA-PILLOW-LARGE |
| 61523 |
| RESMED |
| SWIFT-FX-BELLA-PILLOW-MEDIUM |
| 61522 |
| RESMED |
| SWIFT-FX-BELLA-PILLOW-SMALL |
| 61521 |
| RESMED |
| SWIFT-FX-BELLA-PILLOW-XS |
| 61520 |
No Products to List
MANUFACTURER: FISHER PAYKEL
| BRAND |
| MODEL |
| PRODUCT NUMBER |
| FISHER PAYKEL |
| BREVIDA-NASAL-PILLOW-M/L |
| 400BRE114 |
| FISHER PAYKEL |
| BREVIDA-NASAL-PILLOW-XS-S |
| 400BRE113 |
| FISHER PAYKEL |
| F&P SOLO Nasal Pillow Cushion-S |
| 400SLP114 |
| FISHER PAYKEL |
| F&P SOLO Nasal Pillow Cushion-M |
| 400SLP115 |
| FISHER PAYKEL |
| F&P SOLO Nasal Pillow Cushion-L |
| 400SLP116 |
| FISHER PAYKEL |
| ZEST-FOAM-CUSHN-SIL-SEAL-L |
| 400HC558 |
| FISHER PAYKEL |
| ZEST-FOAM-CUSHN-SIL-SEAL-P |
| 400HC557 |
| FISHER PAYKEL |
| ZEST-FOAM-CUSHN-SIL-SEAL-STD-M |
| 400HC542 |
