Medicare Guidelines for CPAP Replacement
CPAP (continuous positive airway pressure) machines treat obstructive sleep apnea (OSA). Sleep apnea occurs when you stop breathing for brief periods of time while sleeping. Medicare considers CPAP machines to be durable medical equipment, which is covered under Part B of Medicare. There is a replacement schedule set by Medicare that must be followed by CPAP machine suppliers.
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Initial Medicare Coverage
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Medicare requires a clinical CPAP diagnosis done in a sleep lab or with an approved home device. If you meet the criteria, Medicare will cover CPAP for an initial 12-week period. If you need the therapy longer than that, you or your doctor must let your medical equipment provider know by the 61st day of CPAP therapy.
Medicare Replacement Schedule
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Medicare has a set schedule for replacement of each part of a CPAP machine. For example, your full face mask, CPAP mask or oral interface can be replaced as often as every 90 days, but the cushion of your face mask can be replaced every 30 days. Nasal cushions, replacement pillows, tubing and disposable filters can also be replaced as often as every 30 days. Headgear, chinstraps and non-disposable filters can be replaced every six months. The CPAP machine and humidifier can be replaced every five years.
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Ongoing Medicare Coverage
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CPAP therapy falls under Medicare Part B. Medicare Part B has an annual deductible; after the deductible is met Medicare generally covers 80 percent of costs, with 20 percent being the patient's responsibility. The 20 percent remainder is often, but not always, covered by supplementary insurance.
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