HCPCS A7028 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Medical And Surgical Supplies Breathing Aids |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for A7028 |
National average reimbursement for HCPCS A7028 by major payers:
$38.39
$31.27
$39.52
$51.02
HCPCS A7028 vs. Other Breathing Aids Codes
The HCPCS A7028 code is part of the Medical And Surgical Supplies services used for Breathing Aids. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS A7028 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| A7027-HCPCS | Low | Combination oral/nasal mask, used with continuous positive airway pressure device, each |
| A7028-HCPCS | Low | Oral cushion for combination oral/nasal mask, replacement only, each |
| A7029-HCPCS | Low | Nasal pillows for combination oral/nasal mask, replacement only, pair |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS A7028. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the A7028 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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