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HCPCS A7028 Fee Schedule

Last Verified: November 2025

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.

Oral cushion for combination oral/nasal mask, replacement only, each
Key FactDetail
Service Type

Medical And Surgical Supplies

Breathing Aids

Complexity LevelLow

National average reimbursement for HCPCS A7028 by major payers:

bcbs

$38.39

uhc

$31.27

aetna

$39.52

cigna

$51.02

Preview provider-level rates for...
For billing codeHCPCS A7028
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for HCPCS A7028

United
A7028$86.231073502985 - CHU CHEN42484572 - (MA) MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.MAPediatrics Physician (208000000X)
United
A7028$86.231073502985 - CHU CHEN42484572 - (MA) MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.MAPediatrics Physician (208000000X)
United
A7028$86.231073502985 - CHU CHEN42484572 - (MA) MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.MAPediatrics Physician (208000000X)
United
A7028$23.051306540380 - KARLIE RYAN451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALFamily Nurse Practitioner (363LF0000X)
United
A7028$23.051013553197 - AMY MOORE451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALAcute Care Nurse Practitioner (363LA2100X)
United
A7028$23.051790057420 - BAMA HEART DOC, P.C., ALABAMA HEART AND VASCULAR MEDICINE451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALInterventional Cardiology Physician (207RI0011X)
United
A7028$23.051679845531 - DANA HEMSTREET451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALFamily Nurse Practitioner (363LF0000X)
United
A7028$23.051679845531 - DANA HEMSTREET451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALFamily Nurse Practitioner (363LF0000X)
United
A7028$23.051952557498 - JEREMY KELLEY451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALFamily Nurse Practitioner (363LF0000X)
United
A7028$23.051952557498 - JEREMY KELLEY451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALFamily Nurse Practitioner (363LF0000X)
United
A7028$23.051306540380 - KARLIE RYAN451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALFamily Nurse Practitioner (363LF0000X)
United
A7028$23.051790057420 - BAMA HEART DOC, P.C., ALABAMA HEART AND VASCULAR MEDICINE451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALInterventional Cardiology Physician (207RI0011X)
United
A7028$23.051790057420 - BAMA HEART DOC, P.C., ALABAMA HEART AND VASCULAR MEDICINE451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALInterventional Cardiology Physician (207RI0011X)
United
A7028$23.051013553197 - AMY MOORE451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALAcute Care Nurse Practitioner (363LA2100X)
United
A7028$46.811568410264 - TIFT REGIONAL HEALTH SYSTEM, INC., SOUTHWELL MEDICAL453072990 - (GA) TIFT REGIONAL HEALTH SYSTEM INCGAGeneral Acute Care Hospital (282N00000X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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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.

CodeComplexityDescription
A7027-HCPCSLowCombination oral/nasal mask, used with continuous positive airway pressure device, each
A7028-HCPCSLowOral cushion for combination oral/nasal mask, replacement only, each
A7029-HCPCSLowNasal 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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