Does Your Insurance Company Cover CPAP Treatment?

By SA Editor, Oct 8, 2017 | |
  1. SA Editor
    Health insurance is an essential component of a person’s health expenditure plan for treating any ailment and sleep apnea is no exception. Sleep apnea is a chronic condition which requires treatment throughout the person’s lifespan, and health insurance is essential since he would require CPAP machine along with supplies and essentials throughout his lifetime.

    Several insurance companies, to tap into this vast potential market, have started offering coverage for CPAP treatment, though the degree of coverage varies. There are three major types of insurance providers which cater to this market, namely – government providers, provider networks, and private providers.

    Government Providers


    Ensuring good healthcare and proper treatment facilities for every citizen is one of the leading priorities of any government. The US federal government offers various medical insurance programs for qualified citizens. For example, Medicare is provided to US citizens who are aged 65 and above.

    This program is also applicable for younger citizens who have specific disabilities. Medicaid is another government insurance program which aims at providing healthcare to families as well as individuals coming from the low-income strata. For citizens working in the armed forces as well as military, the government offers TriCare health insurance scheme.

    Provider Networks


    Insurance plans offered by provider networks provide a way of bringing down the premiums while aiming to keep out-of-pocket expenses to a bare minimum. For example, policies provided by Health Management Organization (HMO) requires the patient to visit their primary physician and insurance coverage is provided on a group basis.

    There is also the Preferred Provider Organization (PPO) plan, wherein the patient can get lower co-pays if they get treatment from any medical health providers empaneled with a particular insurance company. Within the PPO plan, the patient can also choose Flexible Spending Account (FSA), a sort of payment plan which the doctors themselves offer.

    Besides, there is also a Health Savings Account (HAS), which is a medical fund account that needs a substantial upfront contribution to become eligible. For retirees, insurance companies offer Health Reimbursement Arrangement (HRA) for co-pays and deductibles.

    An important thing to keep in mind regarding the insurance plans provided by provider networks is that if one were to go outside the “network” providers, then the amount of co-pay would end up being substantially higher and in some cases, the patient might have to foot the entire bill from his pocket.

    Private Providers


    Besides the two providers mentioned above, several private insurance companies offer coverage for CPAP treatments. Some of these companies include Anthem, Aetna, Cigna, Blue Cross/Blue Shield, United Health Care and Humana. Though these insurance providers are private, they offer coverage at reasonable premiums.

    Insurance Codes for CPAP Machine, Masks & Supplies


    CPAP/BiPAP Machine Insurance (HCPCS) Codes


    E0601Continuous airway pressure (CPAP/APAP) device
    E0470Respiratory assist device, bi-level pressure (BiPAP) capability, WITHOUT backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)
    E0471Respiratory assist device, bi-level pressure (BiPAP) capability, WITH backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)
    E0472Respiratory assist device, bi-level pressure (BiPAP) capability, WITH backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)
    E0561Humidifier, non-heated, used with positive airway pressure (CPAP/BiPAP/APAP) device
    E0562Humidifier, heated, used with positive airway pressure (CPAP/BiPAP/APAP) device

    CPAP/BiPAP Mask Insurance (HCPCS) Codes


    A7030Full Face Mask used with Positive Airway Pressure (CPAP/BiPAP/APAP) Device
    A7034Nasal interface (mask or cannula type) used with positive airway pressure (CPAP/BiPAP/APAP) device , with or without headstrap
    A7044Oral interface used with positive airway pressure (CPAP/BiPAP/APAP) device
    A7027Combination oral/nasal mask, used with continuous positive airway pressure device

    CPAP/BiPAP Part & Accessory Insurance (HCPCS) Codes


    A7028Replacement Oral Cushion for Combination Oral / Nasal Mask
    A7029Replacement Nasal Pillows Cushion for Combination Oral / Nasal Mask
    A7031Replacement Cushion for Full Face Mask
    A7032Replacement Cushion for Nasal Mask
    A7033Replacement Pillows for Nasal Pillows or Cannula Style Mask
    A7035Headgear used with positive airway pressure device
    A7036Chinstrap used with positive airway pressure device
    A7037Tubing used with positive airway pressure device
    A4604Heated Tubing used with positive airway pressure device
    A7038Filter, disposable, used with positive airway pressure device
    A7039Filter, non-disposable (reusable), used with positive airway presssure device
    A7045Exhalation port with or without swivel used with accessories
    A7046Water chamber for humidifier, used with positive airway pressure device for positive airway pressure devices
    E1399Miscellaneous Durable Medical Equipment Items, Components and Accessories

    Nebulizer & Compressor Insurance (HCPCS) Codes


    E0570Nebulizer, with compressor
    A7005Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable
    A7004Small volume nonfiltered pneumatic nebulizer, disposable
    A7003Administration set, with small volume nonfiltered pneumatic nebulizer, disposable
    A7015Aerosol mask, used with dme nebulizer
    A7014Filter, nondisposable, used with aerosol compressor or ultrasonic generator
    A7013Filter, disposable, used with aerosol compressor or ultrasonic generator
    A4627Chamber, with or without mask, for use with metered dose inhaler

    Light Therapy Device Insurance (HCPCS) Codes


    E0203Light Therapy Device

    O2 Concentrators & Supplies Insurance (HCPCS) Codes


    E1356Oxygen accessory, Battery pack
    E1357Oxygen accessory, Battery charger
    E1358Oxygen accessory, DC Power Adapter
    E1390Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate
    E1392Portable oxygen concentrator
    E0445Oximeter device for measuring blood oxygen levels non-invasively
    A4615Oxygen nasal cannula
    A4616Oxygen supply tubing

    Bottom Line


    While insurance plans, in general, provide succor to patients, when it relates to sleep apnea, coverage would mean the difference between waking up tired and exhausted with unrefreshed sleep and having a comfortable and blissful sleep which can keep any diseases that tend to tag along with sleep apnea, at bay. Sleep apnea, in itself, is not dangerous, but other related symptoms can result in it becoming fatal. Hence, it is vital for a sleep apnea patient to get a proper insurance coverage that offers excellent benefits while undergoing CPAP treatment.

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