Insurance For CPAP Treatment

By | March 25, 2016

Can You Get Insurance Using CPAP Treatment For Sleep Apnea?

For people that follow sleep apnea treatment, CPAP treatment insurance is a must. Obstructive sleep apnea is a chronic and lifelong condition that requires treatment. Not only will you require a CPAP machine, you will also need CPAP supplies, accessories and other essentials to help battle your sleep disorder. There are a number of insurance companies that cover CPAP treatment costs. You may have to pay for the costs up front and then get reimbursed by the insurance company. Associated costs that may be recovered include the following:

  • Cost for a sleep study
  • Diagnosis of Obstructive Sleep Apnea
  • Prescription costs from your physician
  • Cost for CPAP machine and accessories

Most insurance companies will cover the cost for a physician-referred sleep study. While sleep studies have traditionally been performed in a sleep lab during an overnight stay, many other insurance companies now also pay for in-home sleep studies used to diagnose Obstructive Sleep Apnea (OSA).

It is important to contact your insurance company beforehand to determine if they will cover the cost for an in-lab or in-home sleep study and to understand any deductible or co-payment amounts that you may be responsible for. Your insurance company will also be able to assist you in understanding what other costs are covered, what documentation is required from you, and what, if any financial responsibility you may have.

What are the codes my insurance requires when I make a CPAP-related purchase?

The HCPCS (Healthcare Common Procedure Coding System) Code Set is one of the standard code sets used for the purposes of Medicare and other health insurance programs to ensure that these claims are processed in an orderly and consistent manner.

Insurance companies often require a product code called a HCPCS code for claims related to your CPAP purchases. Below is a detailed list of codes your insurance company may need to quickly process your claim. Please note that every insurance company is different and may not accept HCPCS codes for CPAP related equipment.  We have provided a list of HCPCS codes below for your reference.  It is important to note that not all CPAP equipment is eligible for insurance reimbursement so discuss this with your insurance company.

HCPCS Insurance Codes Used for Sleep Apnea Treatment

I will point out that I don’t know if all insurance companies in different countries adhere to this list of codes. I am providing this list of codes for information purposes only. Please check with your own insurance company regarding coverage levels.

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4 thoughts on “Insurance For CPAP Treatment

  1. Linda

    Hi Shawn, I too, have sleep apnea, and have a machine as I sleep each night. I have had to have several mask fittings, trying to find one that works for me. I know Federal Blue Cross & Blue Shield, will pay for two mask fittings, after that I am responsible for the payment. My problem is I can’t keep my mouth shut at night, even with a chin strap, so I am limited to the mask that work for me. Plus, I have leaks, so the air blows in my eyes. They gave me one to try for 30 days that is so neat, can’t remember the name of it, but it fits right under the nose and encloses the mouth. I have had great night’s sleep with this mask! I love your website and I have bookmarked it so I can return and read all of your information! Thank you for such a great website!
    With Kind Regards,
    Linda

    Reply
    1. Shawn

      Hi Linda,
      Thanks so much for your comments, I appreciate it! I’m glad you were able to find a mask that suits you. I currently use a mask that goes over my nose and mouth. So far I haven’t had any problems with it, but I do know people who use the one that only fits over the nose. They seem happy with that one as well. I’ll have to check on the type of mask you use. Perhaps that one would work for me as well!
      Best regards Linda,
      Shawn

      Reply
  2. Rolf K. Bratli

    Hi Shawn,

    this is very vital information for people with sleep apnea. The information regarding insurance cover is comprehensive and to the point!

    It is a well structured website you have here, and I commend you for it! This is solid work, and you will have many visitirs as you increase the number of posts.

    Best regards

    rolfkb

    Reply
    1. Shawn

      Thanks so much Rolf! I really appreciate your comments. I really hope that the information on my site is useful for people with sleep apnea. The list of people I know that have sleep apnea just continues to grow.
      Thanks again Rolf and all the best,
      Shawn

      Reply

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