CPAP / PAP Therapy
E0601 Medicare Reimbursement Research
Coverage, documentation, modifiers, fee references, policy links, and denial risks.
Coverage status
conditional
Documentation required
Yes
F2F/WOPD required list
no
Prescription/order
yes
Prior authorization list
no
Rental or purchase
capped rental
Fee schedule
Available
Same/similar risk
Review required
Code Summary
CPAP device
Conditionally covered for obstructive sleep apnea when the required pre-test clinical evaluation, qualifying sleep test, and supplier instruction criteria in LCD L33718 are met.
Before billing, verify medical necessity, order requirements, proof of delivery, supplier eligibility, correct modifiers, frequency limits, and any applicable LCD or policy article.
Official Sources
officialPositive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L33718)
CMS Medicare Coverage Database / Effective 2024-01-01 / Reviewed 2026-07-09
Initial and continued coverage, replacement, accessory frequency, refill, order, and proof-of-delivery requirements.
Positive Airway Pressure (PAP) Devices Policy Article (A52467)
CMS Medicare Coverage Database / Reviewed 2026-07-09
Coding, modifier, documentation, and policy-specific PAP billing instructions.
Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)
CMS Medicare Coverage Database / Reviewed 2026-07-09
General order, medical record, continued need/use, refill, and proof-of-delivery requirements.
July 2026 DMEPOS Fee Schedule (DME26-C)
Centers for Medicare & Medicaid Services / Effective 2026-07-01 / Reviewed 2026-07-09
Official state and rural/non-rural fee schedule amounts and payment category codes.
DMEPOS Master List and Required Lists Comparison
Centers for Medicare & Medicaid Services / Effective 2026-04-13 / Reviewed 2026-07-09
Current prior authorization and face-to-face/WOPD required-list status.
Reimbursement Status
Coverage is marked conditional. Publication status is verified. This describes the source record, not a claim-specific coverage decision.
Documentation Requirements
Standard written order
A completed SWO must be communicated to the supplier before the claim is submitted.
Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L33718)Proof of delivery
Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.
Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)Qualifying clinical and sleep-test record
Document the applicable clinical evaluation, qualifying sleep test, and device-specific medical necessity criteria.
Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L33718)Continued coverage timing and adherence
For E0601 or E0470 beyond the initial three months, verify the timely treating-practitioner re-evaluation and objective adherence record when applicable.
Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L33718)Standard Written Order / Prescription
A standard written order is required before claim submission.
Clinical Evaluation / Conditions of Payment
An in-person clinical evaluation is required before the sleep test. Continued coverage beyond the first three months requires re-evaluation between days 31 and 91 plus objective adherence evidence.
Rental, Purchase, Replacement, or Supply Logic
Payment category: capped rental. Check same or similar equipment history and replacement eligibility before billing.
Frequency Limits
Frequency and replacement limits are pending research.
Modifiers
NU New equipment
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
RR Rental
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
UE Used durable medical equipment
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
KX Requirements specified in medical policy have been met
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
GA Waiver of liability statement issued
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
GY Item or service statutorily excluded
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
GZ Item or service expected to be denied
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
RA Replacement of DME item
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
Fee Schedule
DME26-C / Effective 2026-07-01
- Non-rural range across fee rows and states
- $50.04 - $100.22
- Rural range where listed
- $86.69 - $97.02
Fee schedule amounts are payment references and do not prove coverage or guarantee payment.
Common Denials
CARC 16: Missing or Invalid Claim Information
Validate required claim loops, provider roles, identifiers, diagnosis pointers, modifiers, units, charges, and payer-specific companion-guide edits before release.
CARC 18: Duplicate Claim or Service
Lock resubmission while a claim is pending, reconcile clearinghouse and payer claim IDs, and require replacement or void indicators for true corrections.
CARC 22: Coordination of Benefits and Payer Order
Ask current coverage and employment questions, verify payer order for the date of service, and transmit complete primary adjudication data on secondary claims.
CARC 29: Timely Filing Denial
Track deadlines from the service-date rule, reconcile payer receipt rather than only transmission, and escalate unaccepted claims well before expiration.
CARC 97: Service Included in Another Payment
Check code-pair edits, global periods, status indicators, payment packaging, and modifier documentation before submitting separate lines.
CARC 109: Claim Sent to the Wrong Payer or Contractor
Validate plan, network, product, payer ID, contractor jurisdiction, and date-specific routing before submission.
Publication and Review Status
Code-level statements have attached official sources. Last reviewed: Jul 9, 2026.