HCPCS A7038 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 |
National average reimbursement for HCPCS A7038 by major payers:
$3.00
$2.58
$2.46
$2.91
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS A7038 | ||||||
United | A7038 | $1.73 | 1639777915 - MOLLY SHINE | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Women's Health Nurse Practitioner (363LW0102X) |
United | A7038 | $1.73 | 1245523117 - MARCOS LOPEZ | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Critical Care Medicine (Anesthesiology) Physician (207LC0200X) |
United | A7038 | $1.73 | 1265851265 - STEPHEN SCHAAF | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Physical Medicine & Rehabilitation Physician (208100000X) |
United | A7038 | $1.73 | 1942935176 - IRENE BEER | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | MD | Speech-Language Pathologist (235Z00000X) |
United | A7038 | $1.73 | 1851957906 - JOSHUA ONYANGO | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | CT | Internal Medicine Physician (207R00000X) |
United | A7038 | $1.73 | 1790865756 - ALISON BARLOW | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Women's Health Nurse Practitioner (363LW0102X) |
United | A7038 | $1.73 | 1225530785 - LILA HUMBERT | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Advanced Practice Midwife (367A00000X) |
United | A7038 | $1.73 | 1245597764 - KATIE DAVIS | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | PA | Diagnostic Radiology Physician (2085R0202X) |
United | A7038 | $1.73 | 1437186418 - JILL GILBERT | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Hematology & Oncology Physician (207RH0003X) |
United | A7038 | $1.73 | 1205910312 - PRATIK PANDHARIPANDE | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Critical Care Medicine (Anesthesiology) Physician (207LC0200X) |
United | A7038 | $1.73 | 1205299989 - BRITTANY GATTA | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | NC | Hospice and Palliative Medicine (Internal Medicine) Physician (207RH0002X) |
United | A7038 | $1.73 | 1144261231 - BRIAN RINI | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Hematology & Oncology Physician (207RH0003X) |
United | A7038 | $1.73 | 1386106136 - ALEXANDRA MAHDASIAN-MILLER | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Obstetrics & Gynecology Physician (207V00000X) |
United | A7038 | $1.73 | 1205097227 - RAIGAN BURKALL-LEWIS | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | MI | Family Medicine Physician (207Q00000X) |
United | A7038 | $1.73 | 1598939985 - JONATHAN KROPSKI | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Pulmonary Disease Physician (207RP1001X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS A7038 vs. Other Breathing Aids Codes
The HCPCS A7038 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 A7038 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 |
|---|---|---|
| A7037-HCPCS | Low | Tubing used with positive airway pressure device |
| A7038-HCPCS | Low | Filter, disposable, used with positive airway pressure device |
| A7039-HCPCS | Low | Filter, non disposable, used with positive airway pressure device |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS A7038. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the A7038 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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