Medicare Coverage Summary
If you have met your deductible for the year, Medicare and most private insurance companies provide excellent coverage for sleep apnea therapy products. The following table illustrates the maximum frequency of product replacement that Medicare will cover. Many private insurance companies choose to use Medicare's reimbursement schedule as their own.
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to check your Medicare Coverage for Sleep Apnea Products.
| Product Category | HCPCS | Maximum Medicare Replacement Schedule |
|---|---|---|
| Tubing with Integrated Heating Element | A4604 | 1 per 3 months |
| Combination Oral/Nasal Mask | A7027 | 1 per 3 months |
| Replacement Cushion for Combination Oral/Nasal Mask | A7028 | 1 per month |
| Replacement Pillows for Combination Oral/Nasal Mask | A7029 | 1 per month |
| Full-Face Mask | A7030 | 1 per 3 months |
| Replacement Cushion for Full-Face Mask | A7031 | 1 per month |
| Replacement Cushion for Nasal Mask | A7032 | 2 per month |
| Replacement Pillow for use on Nasal Mask (cannula/pillow) | A7033 | 2 per month |
| Nasal Mask (mask or cannula/pillow type) | A7034 | 1 per 3 months |
| Headgear | A7035 | 1 per 6 months |
| Chin Strap | A7036 | 1 per 6 months |
| Tubing, Standard | A7037 | 1 per 3 months |
| Disposble Filter | A7038 | 2 per month |
| Non Disposable Filter | A7039 | 1 per 6 months |
| Oral Interface | A7044 | 1 per 3 months |
| Replacement Chamber for Humidifier | A7046 | 1 per 6 months |
| Bi-Level Machine without Back-Up Rate Feature | E0470 | 1 per 5 Years |
| Bi-Level Machine with Back-Up Rate Feature | E0471 | 1 per 5 Years |
| Humidifier, Non-Heated | E0561 | 1 per 5 Years |
| Humidifier, Heated | E0562 | 1 per 5 Years |
| Continuous Positive Airway Pressure ("CPAP") Machine | E0601 | 1 per 5 Years |
As a customer of easybreathe
.com , it's important to note that these are the maximum number of replacement products that Medicare is currently willing to reimburse. More frequent product replacement will lead to improved product performance and greater hygiene.
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