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Medicare may cover a 3-month trial of CPAP therapy devices and accessories if you’ve been diagnosed with obstructive sleep apnea.
Medicare covers CPAP machines under certain conditions. We detail the eligibility requirements & process of purchasing CPAP machines & accessories with Medicare.
Medicare covers CPAP machines under the durable medical equipment benefit if you meet certain requirements. Learn more about costs and coverage.
The use of CPAP is covered under Medicare when used in adult patients with OSA. Coverage of CPAP is initially limited to a 12-week period to identify beneficiaries diagnosed with OSA as subsequently described who benefit from CPAP.
For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements.
Effective for claims with dates of service on and after March 13, 2008, the Centers for Medicare & Medicaid Services (CMS) determines that CPAP therapy when used in adult patients with OSA is considered reasonable and necessary under the under specific situations described in the national coverage determination (NCD).
Medicare can cover durable medical equipment (in this case, your CPAP machine) only if your doctor or supplier is enrolled in Medicare. Your coverage for CPAP therapy comes from Medicare Part B, which includes durable medical equipment or CPAP machines for sleep apnea.
CPAP machines are covered by the Medicare Part B plan under the Durable Medical Equipment coverage. However, to qualify for coverage, you must first be diagnosed with sleep apnea and agree to use your CPAP machine consistently.
Medicare will cover part of the cost of a CPAP machine if you’ve received an obstructive sleep apnea diagnosis. A Medigap plan can help cover your out-of-pocket costs. Original Medicare...
CPAP machines are covered as durable medical equipment under Medicare. However, the Medicare beneficiary must first meet Medicare’s CPAP machine coverage requirements.