Does Medicare Cover CPAP Therapy for Sleep Apnea?

If you’ve been diagnosed with obstructive sleep apnea (OSA), you’re not alone—about 30 million Americans live with the condition. Left untreated, sleep apnea raises the risk of high blood pressure, heart disease, stroke, and serious fatigue-related accidents. Continuous Positive Airway Pressure (CPAP) therapy is the most effective first-line treatment, and for people on Medicare, it’s often covered.

Medicare Part B covers CPAP machines and related supplies as long as your treatment is considered medically necessary and prescribed by a physician. That said, coverage isn’t automatic. To qualify, you’ll need a sleep study, a physician evaluation, and consistent use of your machine that meets Medicare’s compliance rules. If you stop using your device—or don’t use it enough—coverage can be denied or revoked.

This guide walks through everything you need to know: how Medicare coverage works, what sleep studies are accepted, how much you might pay out of pocket, and what steps are involved in getting your CPAP machine and keeping it covered.

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Medicare CPAP Coverage Overview

If you’ve been diagnosed with obstructive sleep apnea and your doctor recommends CPAP therapy, Medicare Part B may help cover the cost—but only if certain conditions are met. This section explains how Medicare categorizes CPAP equipment, what’s included, how billing works, and what medical criteria you’ll need to satisfy before coverage begins.

How Medicare Covers CPAP Machines and Supplies

Medicare considers CPAP machines and supplies to be durable medical equipment (DME) under Part B. If your doctor determines that CPAP is medically necessary for your sleep apnea—and you meet all documentation and usage requirements—Medicare will cover 80% of the approved cost after you meet your annual deductible.

Covered items include:

• A CPAP machine (covered as a rental for 13 continuous months—after which it becomes yours, as long as you meet compliance and medical necessity requirements)
• Accessories like masks, headgear, humidifier chambers, and tubing
• Regular replacement supplies from a Medicare-approved DMEPOS supplier

That last point matters. If your supplier isn’t enrolled with Medicare—or doesn’t accept Medicare assignment—you may end up paying much more out of pocket. Always confirm enrollment status before ordering equipment.

What Medical Criteria Must Be Met

Medicare won’t approve CPAP therapy unless you meet specific clinical guidelines. To qualify:

• You must be diagnosed with obstructive sleep apnea via an approved sleep study
• Your Apnea-Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) must be 15 or higher, or 5–14 if accompanied by qualifying symptoms or comorbidities
• A physician’s prescription—usually from a sleep specialist—must document pressure settings, equipment requirements, and medical necessity
• You must complete a 12-week (90-day) CPAP trial period with documented compliance (defined as use of at least 4 hours per night on 70% of nights)

Compliance data must come from your device itself—not self-reports. Most modern CPAP machines include built-in compliance tracking, and Medicare contractors rely on that data to verify usage.

Diagnosing Sleep Apnea and Qualifying for Coverage

Before Medicare will cover CPAP therapy, you’ll need to be formally diagnosed with obstructive sleep apnea. That diagnosis must come from an approved sleep study and be supported by clear clinical documentation. This section explains the types of sleep studies Medicare accepts—and what your doctor needs to include in your medical records to help you qualify.

Sleep Study Options

Your eligibility for Medicare-covered CPAP therapy starts with a sleep study. Medicare accepts two types of testing, each with distinct use cases.

• In-lab polysomnography (PSG) is the gold standard—a full overnight test conducted in an accredited sleep center. It tracks multiple data points like oxygen saturation, airflow, brain activity, sleep stages, and breathing events.
• Home Sleep Apnea Testing (HST or HSAT) is a more accessible but less comprehensive option. It uses portable equipment and is typically used for patients likely to have moderate-to-severe OSA without significant comorbidities. Medicare covers certain HST devices (Types II, III, or IV) when ordered and interpreted by a qualified provider.

No matter which test is used, it must show that your AHI meets Medicare’s criteria. Your doctor—ideally board-certified in sleep medicine—must also interpret the results and explain how they connect to your clinical symptoms.

What Clinical Documentation Is Needed

Getting a sleep study is only the first step. To qualify for Medicare-covered CPAP therapy, your physician must document not just the results of the test, but also how your symptoms are impacting your health and daily life.

Strong documentation typically includes:

• Evidence of symptoms like excessive daytime sleepiness, cognitive impairment, loud snoring, or witnessed breathing pauses during sleep
• A list of relevant comorbidities such as hypertension, stroke history, diabetes, heart failure, or pulmonary hypertension
• Results from a physical exam that includes assessment of your airway, neck circumference, and other relevant features
• A prescription from a qualified physician that specifies pressure settings, mask style, and equipment needs

Your medical records should paint a clear picture of why CPAP is medically necessary—not just that you technically qualify. Medicare contractors and DME suppliers both use this documentation to verify coverage eligibility.

Types of Sleep Therapy Equipment Covered

Medicare doesn’t just cover one type of sleep apnea device. Depending on your diagnosis, tolerance, and treatment response, several types of machines and mask styles may qualify for coverage.

CPAP, APAP, and BiPAP

Most patients begin therapy with a fixed-pressure CPAP machine, which delivers a single continuous level of airway pressure throughout the night. But not all patients tolerate CPAP equally well, and Medicare recognizes that other machines may be medically necessary.

Here’s how the covered options break down:

• Fixed-Pressure CPAP: The standard model for most Medicare-covered patients
• Auto-titrating CPAP (APAP): Automatically adjusts pressure throughout the night based on breathing patterns—covered when documented as medically necessary
• BiPAP (Bilevel Positive Airway Pressure): Delivers different pressures for inhaling and exhaling; often prescribed if CPAP is poorly tolerated or for patients with neuromuscular conditions or central sleep apnea
• Adaptive Servo-Ventilation (ASV): An advanced device sometimes used for central or complex sleep apnea. Medicare coverage is limited and not approved for patients with certain heart conditions, such as chronic heart failure with reduced ejection fraction.

Each machine must be prescribed with proper documentation. Coverage determinations are based in part on National Coverage Determination (NCD) policies and may also be influenced by public comments and review by the Medicare Coverage Advisory Committee (MCAC) when technology or policy evolves.

Masks and Interfaces

Once a machine type is selected, the next step is choosing a mask. Medicare covers several options to meet individual patient needs, including:

• Nasal masks, full-face masks, and nasal pillows
• Hybrid designs for those needing coverage of both nose and mouth
• Specialty fits, including pediatric sizes and custom interfaces when medically necessary

Replacement masks are covered on a scheduled basis, but switching styles—or needing more frequent replacements—requires documentation of poor fit, intolerance, or skin breakdown. Your DME supplier will also verify that you’re using your current equipment as prescribed before submitting claims for replacements.

CPAP Supply Replacement and Maintenance

CPAP therapy isn’t a one-time setup. To remain effective and safe, supplies need to be regularly cleaned, maintained, and replaced. Medicare covers many of these items—but only within strict quantity limits and usage verification rules.

Covered Supply Items and Schedules

Medicare pays for recurring CPAP supplies according to a set replacement schedule. Some of the most commonly covered items include:

If you need a replacement sooner—due to breakage or hygiene concerns—you’ll need documentation from your provider and confirmation from your supplier that you’re using the equipment as prescribed. Suppliers are required to keep records of usage and must verify compliance before reordering.

Machine Replacement and Upgrades

CPAP machines are eligible for Medicare-covered replacement every five years, assuming you continue to meet medical necessity and usage requirements. Early replacement is sometimes allowed under the following conditions:

• The machine is no longer functioning and out of warranty
• You’ve had a medical condition change that justifies a different device
• Documentation supports the need for a new device

Optional accessories—like heated tubing—may be covered with documentation of medical necessity. Other items, such as travel CPAP units or battery backups, are generally not covered by Medicare.

These requests are often subject to closer review, and coverage rules may vary depending on whether you’re using Original Medicare or a Medicare Advantage plan with different supplier enrollment requirements or network restrictions.

Compliance and Ongoing Coverage Requirements

Getting Medicare to cover your CPAP machine is just the beginning. Keeping that coverage active depends on how often and how consistently you use it. Medicare tracks your usage closely—and noncompliance can jeopardize future coverage. This section covers what counts as compliant, what can go wrong, and how to stay on track.

Medicare CPAP Usage Rules

To keep your CPAP covered, Medicare requires that you:

• Use the machine for at least 4 hours per night
• Meet that usage target on 70% of nights
• Do this within a consecutive 30-day period, starting from the day you begin therapy

This initial trial is sometimes called the 12-week trial period or CPAP adherence window, and it’s a critical step. Your machine must be equipped to track usage automatically—Medicare does not accept self-reporting. Usage data must be downloaded or transmitted and reviewed by your doctor or equipment supplier.

If you meet these requirements, Medicare will continue paying for your machine (through month 13) and supplies. But if you don’t meet compliance requirements, Medicare coverage ends. To restart, you must have a new face-to-face evaluation and meet the criteria again, including a repeat sleep study if medically necessary.

Common Compliance Barriers (and Fixes)

Even patients who know the benefits of CPAP therapy sometimes struggle to stick with it. The good news is that most issues have solutions—with the right support.

Common problems include:

• Discomfort or poor mask fit, causing pressure points or leaks
• Claustrophobia or anxiety, especially when first starting out
• Dry mouth, nasal congestion, or sore throat, often from lack of humidification
• Sleep disruption, especially for partners who are bothered by noise or airflow

Solutions can include switching to a different mask style, adjusting your humidity settings, using a ramp feature to ease into therapy, or seeking behavioral coaching. Solace advocates can help coordinate these changes with your supplier or doctor so you’re not stuck troubleshooting alone.

Step-by-Step: How to Get Medicare-Covered CPAP

Qualifying for Medicare-covered CPAP involves more than just a diagnosis. It’s a staged process that requires provider coordination, documented medical necessity, equipment setup, and adherence monitoring. Below is a breakdown of what typically happens—week by week.

Phase 1: Sleep Evaluation and Testing (Weeks 1–4)

1. Primary Care Assessment
   • Your doctor evaluates your symptoms and medical history: This includes asking about fatigue, snoring, memory issues, and sleep disruptions.
   • They perform a physical exam, including your upper airway: Your provider checks for signs like a recessed jaw, large tonsils, or a thick neck that might contribute to airway blockage.
   • Comorbid conditions like hypertension or heart disease are documented: These health issues increase the urgency and likelihood of Medicare approval.
   • A referral is made to a sleep specialist or center: Medicare generally requires a specialist’s input before CPAP can be approved.
   • Insurance verification and prior authorization begin, if needed: Your care team checks that everything is in place for Medicare to cover the sleep study and related steps.
2. Sleep Study Scheduling and Completion
   • You schedule either an in-lab PSG or a home sleep test (HST): Your provider helps determine which test is appropriate based on your risk level and other conditions.
   • You receive instructions and complete the study: This may involve prep guidelines, using take-home equipment, or staying overnight in a sleep lab.
   • A physician interprets the results: A trained specialist analyzes your breathing data, AHI score, oxygen levels, and sleep quality.
   • A formal diagnosis is made and documented: If your results meet Medicare’s thresholds, the diagnosis of obstructive sleep apnea is recorded in your chart.
   • CPAP therapy is recommended if criteria are met: If your AHI is high enough—and other clinical findings support it—your provider will recommend starting CPAP.

Phase 2: CPAP Prescription and Equipment Selection (Weeks 4–6)

1. Sleep Specialist Consultation
   • Your provider reviews the sleep study findings: They explain your AHI score and how it relates to Medicare coverage.
   • They write a prescription with pressure settings and device type (e.g., CPAP, APAP): This script must be detailed enough to meet documentation standards.
   • You discuss expectations, possible side effects, and next steps: This includes learning about noise levels, dry mouth, mask options, and how success will be measured.
   • The provider coordinates with a DME supplier for equipment fulfillment: They send the prescription and documentation directly to a Medicare-enrolled supplier.
2. DME Supplier Selection and Setup
   • You choose a Medicare-approved supplier: Not all suppliers accept assignment, so it’s important to confirm before moving forward.
   • The supplier confirms insurance coverage: They verify your eligibility and benefits to prevent surprise costs.
   • You schedule your CPAP setup and training: This may happen at home or in the supplier’s office, depending on the vendor.
   • Mask fitting and comfort adjustments are performed: You’ll try different mask types to find one that seals well and feels manageable.
   • Initial pressure titration or machine calibration is completed: Your machine is set to the correct pressure based on your prescription or auto-adjusts if it’s an APAP.

Phase 3: CPAP Initiation and Compliance Monitoring (Weeks 6–10)

1. CPAP Therapy Initiation
   • You begin nightly use of your CPAP machine: You’ll start using the device during sleep and work through any adjustment issues.
   • Any side effects are monitored and addressed: Your provider or supplier can help with skin irritation, dryness, or anxiety about wearing the mask.
   • You receive support for troubleshooting discomfort or adjustment issues: This may include mask swaps, humidifier tweaks, or ramp feature activation.
   • Usage is tracked automatically by the machine: Medicare requires objective data, which is collected by your device and shared with your care team.
   • You follow up with your provider to review early progress: This visit is key to ensuring compliance and may lead to changes in your equipment setup.
2. 30-Day Compliance Assessment
   • Your provider downloads and reviews your usage data: They check whether you’ve met the minimum hours needed to qualify for continued coverage.
   • Clinical response and symptom improvements are documented: Your provider notes whether you're feeling more rested, alert, or healthier overall.
   • Adjustments are made if problems are identified: These may include pressure changes, mask replacements, or referrals for behavioral support.
   • Compliance is recorded to maintain Medicare coverage: If your data confirms you’re meeting the criteria, coverage continues without interruption.
   • Medicare also requires a face-to-face follow-up visit with your physician between day 31 and day 90 of the trial to document CPAP effectiveness and continued medical necessity.

CPAP Costs and Financial Support

CPAP therapy is a covered Medicare benefit—but it’s not always free. How much you pay out of pocket depends on your coverage type, whether your supplier accepts assignment, and if you have any secondary insurance. Here's what to expect.

Medicare Cost Breakdown

Under Original Medicare:

• CPAP machine rental: Medicare pays 80% of the approved rental cost each month after you meet your deductible. Exact amounts vary by supplier and region.
• Supply costs: ~$20–$50/month, also covered at 80%
• Deductible: $257 annually (2025)
• Coinsurance: 20% of Medicare-approved amounts

If your DME supplier doesn’t accept assignment, you could owe more. Always confirm supplier status in advance.

Supplemental Coverage and Cost Management

To lower out-of-pocket costs, some patients use:

• Medigap plans, which often cover coinsurance and deductibles
• Medicare Advantage (Part C) plans, which may offer different DME terms or supplier networks
• Medicaid, for dual-eligible patients
• VA benefits, for veterans with service-connected OSA or related conditions

Cost-saving tips also include comparing supplier pricing, choosing generic accessories when possible, and asking your supplier about manufacturer assistance programs.

What to Do If Coverage Is Denied

Even if you’ve followed all the steps, Medicare coverage for CPAP therapy can be denied—especially if documentation is incomplete or compliance requirements haven’t been met. The good news: denials are often fixable with the right paperwork, clarification, or appeal.

Common Reasons for Denial

Some of the most frequent reasons Medicare denies CPAP coverage include:

• AHI or RDI score too low to meet national coverage determination (NCD) criteria
• Missing documentation, such as a physician prescription or sleep study interpretation
• Non-compliance with Medicare’s 12-week usage requirement (at least 4 hours per night on 70% of nights)
• Using a non-enrolled or non-assignment-accepting supplier, which can lead to full patient responsibility

If you’re denied, you’ll receive a written notice explaining the decision. You have 120 days from the date of that notice to file a Level 1 appeal (redetermination).

How to Strengthen an Appeal

To give your appeal the best chance of success, include:

• A copy of your sleep study with AHI/RDI data clearly visible
• A letter from your physician explaining your diagnosis and medical necessity
• Documentation showing your symptoms, comorbidities, and response to therapy
• Usage data pulled from your machine if the issue is related to compliance
• Confirmation that your supplier is Medicare-enrolled and operating within DMEPOS standards

Higher levels of appeal—like reconsideration or an administrative law judge hearing—are available if your redetermination is unsuccessful.

How Solace Advocates Can Help

Medicare’s process can feel like a maze—especially when you're tired, frustrated, or dealing with conflicting provider and supplier information. That’s where Solace comes in.

Our advocates help patients at every stage of the CPAP coverage journey, from diagnosis to long-term therapy support.

Here’s what we offer:

• Before coverage: We help schedule sleep studies, gather documentation, confirm eligibility with your plan, and work with your doctors to submit the right paperwork and get your coverage approved
• During setup: We help you find enrolled DME suppliers, review equipment options, and make sure you’re set up with the right mask and training support
• For ongoing support: We check in on how therapy is going, help you talk to your supplier about equipment issues, and coordinate follow-up care with your doctors
• When issues arise: We handle appeals, billing questions, and communication with Medicare or suppliers

You don’t have to go through this alone. We’re here to help you breathe easier.

FAQ: Frequently Asked Questions About Medicare CPAP Coverage

What sleep study results qualify for Medicare CPAP?

Medicare requires that your sleep study show an Apnea-Hypopnea Index (AHI) of 15 or higher, or an AHI between 5 and 14 if you also have documented symptoms or comorbidities like hypertension, heart disease, or stroke. The sleep study must be properly interpreted and documented by a qualified provider.

How much will I pay out of pocket?

After you meet your Part B deductible ($257 in 2025), Medicare pays 80% of the approved amount for your CPAP machine rental and supplies. You’ll be responsible for the remaining 20% coinsurance, unless you have a Medigap, Medicaid, or Medicare Advantage plan that covers it.

What if I don’t use CPAP every night?

Medicare requires that you use the CPAP for at least 4 hours per night on 70% of nights during a 30-day period to maintain coverage. If you don’t meet this CPAP compliance requirement, coverage may be paused or revoked unless your provider documents valid clinical reasons for restarting therapy.

Can I choose any CPAP model?

You can choose from CPAP machines that are Medicare-approved and available through enrolled DME suppliers. Luxury features (like smartphone connectivity, travel-size models, or quiet motors) may not be covered unless they’re documented as medically necessary.

What happens if I can’t tolerate CPAP?

If you struggle with mask fit, discomfort, or pressure settings, your doctor may recommend switching to a different mask interface or upgrading to APAP or BiPAP therapy. Medicare may cover these alternatives if you meet the clinical criteria and your physician provides justification.

How often can I replace supplies?

Medicare follows a strict replacement schedule. For example:

• Mask: every 3 months
• Cushions/seals: monthly
• Tubing: every 3 months
• Filters: monthly or every 6 months
• These quantities must be verified by usage data from your DME supplier.

What if my machine breaks?

If your CPAP machine malfunctions and is no longer under warranty, Medicare may cover a replacement—as long as it’s been medically necessary and five years have passed since your original device. You may need documentation from your supplier or provider to confirm the need.

Can I travel with my CPAP?

Yes. Most standard CPAP machines are portable and can be taken on planes or stored in carry-on luggage. However, Medicare typically does not cover travel CPAP machines—smaller, lightweight units designed specifically for convenience. In rare cases, coverage may be approved with strong medical documentation and prior authorization, but this is not common. If you travel frequently, you may need to purchase a travel CPAP out of pocket.

This article is for informational purposes only and should not be substituted for professional advice. Information is subject to change. Consult your healthcare provider or a qualified professional for guidance on medical issues, financial concerns, or healthcare benefits.

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