Specialty reimbursement hub

CPAP / PAP Supplies Medicare Reimbursement Hub

This hub organizes Medicare reimbursement research for PAP devices, masks, tubing, filters, humidifiers, and replacement supplies.

Key HCPCS Codes

E0601

CPAP device

conditional

Specialty: CPAP / PAP Supplies
Publication: verified
Fee reference: Available
Documentation: Required

Open record

E0470

Respiratory assist device, bilevel pressure capability, without backup rate

conditional

Specialty: CPAP / PAP Supplies
Publication: verified
Fee reference: Available
Documentation: Required

Open record

E0471

Respiratory assist device, bilevel pressure capability, with backup rate

conditional

Specialty: CPAP / PAP Supplies
Publication: verified
Fee reference: Available
Documentation: Required

Open record

E0562

Heated humidifier

conditional

Specialty: CPAP Accessories
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A4604

Heated tubing

conditional

Specialty: CPAP Accessories
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A7027

Combination oral/nasal mask

conditional

Specialty: CPAP Masks
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A7028

Oral cushion

conditional

Specialty: CPAP Masks
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A7029

Nasal pillows for combination oral/nasal mask

conditional

Specialty: CPAP Masks
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A7030

Full face mask

conditional

Specialty: CPAP Masks
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A7031

Full face mask interface replacement

conditional

Specialty: CPAP Masks
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A7032

Nasal cushion

conditional

Specialty: CPAP Masks
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A7033

Nasal pillows

conditional

Specialty: CPAP Masks
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A7034

Nasal interface

conditional

Specialty: CPAP Masks
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A7035

Headgear

conditional

Specialty: CPAP Accessories
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A7036

Chinstrap

conditional

Specialty: CPAP Accessories
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A7037

Tubing

conditional

Specialty: CPAP Accessories
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A7038

Disposable filter

conditional

Specialty: CPAP Accessories
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A7039

Non-disposable filter

conditional

Specialty: CPAP Accessories
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A7044

Oral interface

conditional

Specialty: CPAP Masks
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A7045

Exhalation port

conditional

Specialty: CPAP Accessories
Publication: verified
Fee reference: Available
Documentation: Required

Open record

A7046

Water chamber

conditional

Specialty: CPAP Accessories
Publication: verified
Fee reference: Available
Documentation: Required

Open record

HCPCS	Description	Specialty	Coverage	Documentation	Rental/Purchase	Fee Reference	Research Status	Confidence	View
E0601	CPAP device	CPAP / PAP Supplies	conditional	Required	capped rental	Available	verified	Verified	Open
E0470	Respiratory assist device, bilevel pressure capability, without backup rate	CPAP / PAP Supplies	conditional	Required	capped rental	Available	verified	Verified	Open
E0471	Respiratory assist device, bilevel pressure capability, with backup rate	CPAP / PAP Supplies	conditional	Required	capped rental	Available	verified	Verified	Open
E0562	Heated humidifier	CPAP Accessories	conditional	Required	rental or purchase	Available	verified	Verified	Open
A4604	Heated tubing	CPAP Accessories	conditional	Required	supply	Available	verified	Verified	Open
A7027	Combination oral/nasal mask	CPAP Masks	conditional	Required	supply	Available	verified	Verified	Open
A7028	Oral cushion	CPAP Masks	conditional	Required	supply	Available	verified	Verified	Open
A7029	Nasal pillows for combination oral/nasal mask	CPAP Masks	conditional	Required	supply	Available	verified	Verified	Open
A7030	Full face mask	CPAP Masks	conditional	Required	supply	Available	verified	Verified	Open
A7031	Full face mask interface replacement	CPAP Masks	conditional	Required	supply	Available	verified	Verified	Open
A7032	Nasal cushion	CPAP Masks	conditional	Required	supply	Available	verified	Verified	Open
A7033	Nasal pillows	CPAP Masks	conditional	Required	supply	Available	verified	Verified	Open
A7034	Nasal interface	CPAP Masks	conditional	Required	supply	Available	verified	Verified	Open
A7035	Headgear	CPAP Accessories	conditional	Required	supply	Available	verified	Verified	Open
A7036	Chinstrap	CPAP Accessories	conditional	Required	supply	Available	verified	Verified	Open
A7037	Tubing	CPAP Accessories	conditional	Required	supply	Available	verified	Verified	Open
A7038	Disposable filter	CPAP Accessories	conditional	Required	supply	Available	verified	Verified	Open
A7039	Non-disposable filter	CPAP Accessories	conditional	Required	supply	Available	verified	Verified	Open
A7044	Oral interface	CPAP Masks	conditional	Required	supply	Available	verified	Verified	Open
A7045	Exhalation port	CPAP Accessories	conditional	Required	supply	Available	verified	Verified	Open
A7046	Water chamber	CPAP Accessories	conditional	Required	supply	Available	verified	Verified	Open

Coverage themes

PAP equipment follows initial qualification, continued coverage, replacement, and accessory pathways in LCD L33718. E0471 billed for primary OSA follows a different coverage result than E0601 or E0470.

Documentation themes

Review the SWO, clinical and sleep-test record, supplier instruction, continued coverage timing and adherence when applicable, refill request, utilization, and proof of delivery.

Modifier Notes

24 25 26 50 51 52 53 57

Common Denial Risks

CARC 16: Missing or Invalid Claim Information CARC 18: Duplicate Claim or Service CARC 22: Coordination of Benefits and Payer Order CARC 29: Timely Filing Denial CARC 97: Service Included in Another Payment CARC 109: Claim Sent to the Wrong Payer or Contractor

Important: Fee schedule amounts and code references do not guarantee coverage or payment. Verify billing decisions with official Medicare sources, DME MAC guidance, and qualified compliance professionals.

lcd

Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L33718)

Initial and continued coverage, replacement, accessory frequency, refill, order, and proof-of-delivery requirements.

Reviewed 2026-07-09

policy article

Positive Airway Pressure (PAP) Devices Policy Article (A52467)

Coding, modifier, documentation, and policy-specific PAP billing instructions.

Reviewed 2026-07-09

standard documentation

Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)

General order, medical record, continued need/use, refill, and proof-of-delivery requirements.

Reviewed 2026-07-09

Related Specialties

Oxygen Equipment Diabetic Supplies & CGM

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