Regarding insurance coverage for CPAP machines or BiPAP machines, Medicare will usually cover 80% of the cost of sleep therapy machines. Other PPO insurances and state Medicaid plans vary on how much they cover, but some pay up to 100%. CPAP Machines and BiPAP machines are generally purchased through a 13 month rental process. During these 13 months, your insurance will be billed at a monthly rental rate that will then be converted to a purchase after the rental period is expired. You will then own the CPAP machine once the allowed amounts by your insurance have been paid in full. Generally speaking, Medicare and most private insurances will pay for a new CPAP machine or BiPAP machine every 5 years.
Medicare and private insurances have certain qualifications that must be met before they will cover a CPAP machine or BiPAP machine.
- You must have had a sleep study performed at an accredited sleep clinic.
- Your Apnea Hypopnea Index (AHI) must be greater than 15 episodes per hour. Or your AHI must be from 5-15 per hour and accompanied with symptoms of excessive daytime sleepiness, impaired cognition, mood disorders, and/or insomnia.
- The diagnostic portion of your sleep study must reflect a minimum of 2 hours of sleep time.
- You must also be able to provide a titration study as well as a signed prescription or a letter of Medical Necessity from your doctor stating that you are eligible to receive the sleep therapy equipment.
*Please note that Medicare and some private insurances have implemented new guidelines regarding the usage of CPAP machines and BiPAP machines. Medicare requires the patient’s CPAP machine usage be monitored for 90 consecutive days upon initial setup to ensure the patient is using the machine for 4 hours or more for at least 21 of any 30 day period.
Submit your information to Tibro Medical today! We will assign one of our sleep therapy and insurance experts to ensure you get the service you deserve and pay as little out of pocket as possible depending on your insurance coverage!
Medicare and many insurance companies provide for regular maintenance and will cover up to 100% of the cost of CPAP machine supplies although each insurance varies (Medicare covers 80%). Tibro Medical is committed to making this process as easy as possible for you and offers free shipping. Submit your information NOW and a trained sleep therapy expert will reach out to you TODAY.
Below is a summary of CPAP machine supplies and recommended replacement schedule:
|HCPCS Code||Description||Allowed Replacement Schedule|
|A7030||Full Face Mask||1 every 90 days|
|A7031||Full Face Cushion||1 every 30 days|
|A7034||Nasal Mask||1 every 90 days|
|A7032||Nasal Mask Cushion||2 every 30 days|
|A7033||Nasal Pillows||2 pairs every 30 days|
|A7035||Headgear||1 every 180 days|
|A7036||Chinstrap||1 every 180 days|
|A7037||Tubing||1 every 90 days|
|A7039||Non-Disposable Filters||1 every 180 days|
|A7038||Disposable Filters||2 every 30 days|
|E0601||CPAP Machine||Generally every 5 years|
|E0470||BiPAP Machine||Generally every 5 years|
Submit your information to Tibro Medical today! Submitting claims and ensuring you have the proper paperwork to have your insurnance pay for your CPAP machine, BiPAP machine, and CPAP mask and related supplies can be overwhelming. Let Tibro Medical be your sleep therapy partner to ensure you have the best quality of care possible. That’s our goal.