Will my Insurance Cover CPAP? Frequently Asked Questions About Coverage

If you have a diagnosis of sleep apnea, your insurance company will probably cover the cost of your CPAP or bi-level PAP device; however, coverage varies from plan to plan and so do authorization requirements.

Read more about insurance coverage below. We’ll answer the basic questions, like what will I have to pay?, rental vs. purchase and some of the more technical questions, like what are the codes?

What is the difference between device rental and purchase?

Many insurance companies now pay for PAP devices on a monthly rental basis, typically 3 to 10 months. At the end of this period you will own the device. Because it is a monthly rental, your provider will bill your insurance company monthly. If you have a co-insurance, you will also be billed monthly (to learn more about the difference between co-insurance, co-pay, deductible and more insurance terms, check out our Guide to Understanding Your Health Insurance).

How long is the rental term?

The most common options:

  • 3 month rental, 4th month purchase (many PPO insurances)
  • 10 month rental (most HMO insurance and some PPO insurances)
  • 13 month rental (Medicare and other government insurance)

How do I know if my insurance pays for rental or purchase?

You can either ask your provider or contact your insurance company. When your provider verifies your insurance benefits and coverage they will find out the terms of the rental or purchase and should be able to provide you with an estimate of your expected financial responsibility at the time of set-up and monthly for the term of your rental. Unfortunately, patients and providers have no control over whether CPAP is covered as rental or purchase.

How much will I pay for a purchase?

If your provider is in-network, they have negotiated rates with your insurance company for your PAP device. There may be a big difference between what you pay if you go with a provider that is in-network rather than one that accepts your insurance, but is not in-network (click here to learn more about the difference and what it means to patients). The cost also varies by type of device. A CPAP or APAP will cost less than a BiPAP or bi-level device (click here to learn more about different types of PAP devices).

At the time of your set-up you will also receive a mask, tubing, filters and cushions that will need to be replaced in the future (more about that later). It’s best to speak with your provider or contact your insurance to get the actual price. 

How much will I pay for a rental?

Typically, the rental charges are determined by dividing the purchase price of the device by the number of months in the rental term. Read “How much will I pay for a purchase?” above to learn more about purchase costs. 

It’s important to remember that your first month’s bill will include the purchase of the mask, tubing, filters and cushions that were provided during your set-up. You will be charged for those items for future rental months, only when you order additional replacement supplies, usually every three months.

Will my insurance company require authorization for my CPAP?

Many insurance companies, including Medicare and PPO plans, are now requiring authorizations for more and more services, including sleep studies and PAP devices. Many device providers will request authorization from your insurance company, if needed. They will usually require a prescription and your most recent sleep study showing a diagnosis of sleep apnea. If you’re a current CPAP user and are getting a replacement device, you may need a new sleep study. Typically, insurance companies will require a new sleep study every three years.

What are the codes for CPAP and supplies?

Continuous PAP (CPAP) or Autoset PAP (APAP): E0601

Bilevel PAP (BiPAP): E0470

BiLevel with pressure support (ASV): E0471

Heated humidifier: E0562

Waterchamber: A7046

Mask* (nasal or nasal pillows): A7034    Full-face mask: A7030    Headgear: A7035    Chinstrap: A7036

Nasal mask cushion: A7032    Nasal pillows cushion: A7031    Full-face mask interface: A7033

Disposable filters: A7038

Tubing: A7037    Heated tubing: A4604

*Due to Medicare regulations, which may be followed by your insurance, your mask kit will be billed using two separate codes. According to your mask type you will find the following combination of codes on your order invoice: either (A7030 & A7035) or (A7034 & A7035). Codes A7034 and A7030 refer to the frame of your mask, while A7035 refers to the headgear. Although they are billed separately they come assembled in the same bag.

Why does my insurance require proof of usage?

Your insurance company wants to make sure that you are using the device on a regular basis to improve your health. They do not want to pay for a device that you are not using. Therefore, many insurance companies that pay for CPAP on a rental basis are now requiring proof of compliance in order to continue the device rental or before they will purchase the device for you.

Compliance guidelines:

Most insurance compliance guidelines require that you show proof of using your device for a minimum of 4 hours per day at least 22 days out of a consecutive 30 day period within the preceding 90 days (in the past 3 months).

How often will my insurance pay for a new device?

Many insurance companies will cover a new device every three to five years. You may also need a new sleep study before your insurance company will authorize the new device. The insurance companies want to make sure that you still need the device and that your current settings are appropriate. Due to weight loss or gain or other changes to your health, you may require a higher or lower pressure setting.

How often will my insurance pay for replacement supplies?

Your CPAP’s accessory equipment is a lot like other frequently used health products, such as your toothbrush or a razor: it deteriorates, ceases to function optimally, and can get germy and unsanitary. Just like you wouldn’t use the same toothbrush for months on end, it’s important to replace your CPAP equipment to make sure that your machine is as clean, effective, and comfortable as possible. There are three main reasons you should regularly replace your PAP equipment: 

  1. Hygiene. PAP equipment, such as tubing and masks, can get germy over time. Replace regularly to keep your machine sanitary. 
  2. Effectiveness. It is vital that your equipment be replaced regularly so that it functions properly. For instance, as masks age, they can crack or stretch, causing irritation and leaks. 
  3. Comfort. Old equipment, especially masks and cushions, can irritate your face and lead to lack of compliance. 

Certain supplies need be replaced anywhere from every two weeks to every six months. Generally, insurance companies will authorize replacement of CPAP masks, tubing and filters every 90 days. Many insurance plans follow the guidelines from Medicare for regular replacement of supplies. You can review the guidelines online at  http://oig.hhs.gov/oei/reports/oei-07-12-00250.pdf. 

Medicare guidelines suggest replacing your supplies at the following frequency:

Supply replacement schedule

Can I pay cash for my CPAP?

Of course! Most providers (like us) offer cash rates for PAP devices and replacement supplies. You may save money and you will definitely save the hassle of dealing with your insurance company. A prescription from your physician and recent sleep study report are still required even for cash purchases.

Do you need a CPAP? We’re contracted with all major PPOs, government insurances and many HMOs. See a full list of insurances here.

Contact us to schedule a face-to-face set-up today!

Request CPAP appt.

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  1. Doris Gunter Reply

    Do i need a sm card for the doctor

    • Julia Rodriguez Reply

      Hi Doris. If your physician would like to see your compliance data (or it’s required by your insurance company) you will need either a data card or a CPAP with a wireless modem.

  2. Misty Reply

    Once the four months of rental is over and we purchase the machine, do they still need to track the data over wireless as the machine is technically now ours? Our can we disable that feature?

  3. Stephen Despres Reply

    I got a letter from my insurance saying that my request for coverage of services has been authorized. 7 monthly rental units. Then it says 10 months. Does this mean that I was compliant with the usage hours? Am I in the clear to keep the machine?

  4. br Reply

    I have a situation where I had to transition insurance providers in the midst of my installment-to-own plan. With Cigna it was pay 6 months of installments (and ensure compliance) to own the device thereafter. With Blueshield of CA now, Apria has restarted the installment clock and now says they will bill 10 months of installments after which it is still considered a rental but no charges are due.
    I’m stuck between Apria & blueshield. Any suggestions on how I approach this ?

  5. John Chavis Reply

    would like to talk to someone about a bipap/bilevel pressure device need help getting one

  6. Tim Reply

    I received my Cpap machine 3 weeks ago I can’t get used to it
    I’m not going to continue,can I get my money I put down back

  7. John M Burnaman Reply

    hown long does a cpap machine last and even though it works should i get it replaced anyways

  8. Sue Clark Reply

    I entered CPAP from dme 13 month. After 10 months Ichanged Ins co.
    Dme is telling my Inow have to pay 13 more payments. Is that right? Thanks

  9. Mike corbin Reply

    My CPAP shows motor life exceeded. How long will it continue to work. I am not eligible to get a new one until January 20th.

  10. V Reply

    My insurance bluecross is making me pay 3,000 dollars.. But that’s not even the cost of the machine..plus after the doctors told my insurance that I have sleep apnea REALLY REALLY BAD, they dont care, and it’s been almost a year and I still dont have the darn thing..

  11. Pau Hoffman Reply

    very helpful and thorough article – thank you!

  12. Victoria Riggin-Bundick Reply

    How can I find a CPAP supply provider that is considered in network with aetna insurance? I wish to order online and have my insurance billed.

  13. Kim Reply

    I don’t understand how I go from paying 42.96 per month rental for cpap. This month I have a bill for 202.04 because I have a 198.00 deductible due. I just need to understand what is my deductible covering?

    • Steve H Reply

      Did you ever get clarification? I have the EXACT same situation happening. I paid 12.75 for my 10 months and now I have a bill for 228.75. They say I haven’t paid my deductible yet. That wasn’t in the original agreement. I was told 10 payments and it was mine. Besides, my deductible is 350, so it doesnt even make sense.

  14. Albert Compoly Reply

    Yeah, it’s ok for an insurance company to pay $4 for an aspirin or a cotton ball when your in a hospital, but they are nickel and diming & monitoring us on use of a Cpap machine they say they don’t want to pay for if we’re not using it. How about monitoring those aspirins and cotton balls !

    • Cherie Reply

      IT’s discrimination!
      Insurance company’s don’t ask for requirements on use of medication they pay for to treat illness such as heart, diabetes or COPD and continue to smoke.

  15. Angie Lopez Reply

    My elderly father of 91 is in need of a new CPAP machine. He has Medicare and I am not sure what can be done to get him a more updated machine for him his current machine is not working properly anymore and his is on a fixed income. My fathers name is Francisco Parra.

  16. Susan Johann Reply

    I am still using my cpap, but not as I’m supposed to be using it. It became too loud to sleep with. I was changing filters and washing the long term filter regularly, but i found that the noise was greatly reduced with no filters in it. It still blows air into my nose and keeps my nostrils open, so I keep using it. My AHI and other info looks good. I was told I could take it in and get an estimate on repair, but that would be an all-day excursion with the potential result being an estimate that is more than I can afford. It’s too bad that the medical supply company and insurance have no further responsibility for repairing problems that arise once we own the machines. Plus, i shudder to think about the disposal of broken cpaps in landfills, and plastic seeping into water supplies. Pretty disgusting, and something I’d prefer not to be part of

  17. Riley Nixon Reply

    Great job. Keep sharing.

  18. Jose Antonio Ramirez II Reply

    Need to know if you guys take Tricare Insurance

  19. Mary ann Smith Reply

    I can’t use my CPAP machine because when I inhale/exhale, there is a whistling noise that prevents me from going to sleep.
    What causes that noise? I really need to get back to using it, since i am a walking zombie during the day. Can you help?

  20. sloe unblocked Reply

    Thank you so much for giving this quite useful knowledge.
    Is there a list of Medicare approved masks? I switched on my own to a Res Med Swift FX Bella from a Dreamwear nasal pillow mask. I did not like the over the head mask. I can still order the long hose from a Medicare supplier & my MD is aware of my change, but I have been buying the replacement mask parts on my own.

  21. Anna Reply

    ey will usually require a prescription and your most recent sleep study showing a diagnosis of sleep apnea. If you’re a current CPAP user and are getting a replacement device, you may need a new sleep study. Typically, insurance companies will require a new sleep study every three years.

  22. Tom Blair Reply

    There may be a big difference between what you pay if you go with a provider that is in-network rather than one that accepts your insurance.

  23. talentcreation Reply

    Thank you so much for sharing this quite useful information.
    Is there a list of masks that Medicare approves? I moved from a Dreamwear nasal pillow mask to a Res Med Swift FX Bella on my own. The over-the-head mask did not appeal to me. I can still get the long hose from a Medicare provider, and my doctor is aware of my new situation, but I’ve been purchasing replacement mask pieces on my own.

  24. David Grunwald Reply

    CPAP is good if your significant other can tolerate the whistling noise it makes everytime you take a breath

  25. Antony Ravn Reply

    I have sleep apnea and use CPAP and it makes a large noise. Wish there was an alternative with sound proofing

  26. AAATS-Hatfield Reply

    If it’s not treated, sleep apnea can cause a number of health problems, including hypertension, stroke, cardiomyopathy, heart failure, diabetes and heart attacks. So insurance should cover the basic treatment for apnea, the CPAP

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  37. Lois Reply

    I know that my insurance pay for my cap supplies because I ordered them for rotech at the store in laffollette tn store my supplies for sept ihavent got and l need them now. Please send them to me

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    CPAP is a lifesaver for a few friends of mine. It helps them to prevent frequent hospital admissions. So coverage for CPAP would be beneficial for BIG Insurance in long term

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    The study examined person-to-person sales of CPAP devices at a range of geographic locations, median incomes, population densities and number of sleep clinics.

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