Medicare guidance
Medicare Coverage for CPAP and Sleep Apnea
Understand Medicare sleep-study and CPAP coverage, the initial trial, continued-use documentation, equipment suppliers and questions to ask before a rental begins.
Start with the evaluation
A Sleep Test and a CPAP Rental Are Separate Steps
Your clinician decides whether a sleep-apnea evaluation is appropriate and orders the test. Medicare covers eligible sleep studies under Part B; where the test can occur depends on the type. A supplier’s offer of a machine is not a substitute for the clinical evaluation and required documentation.
Before the test, ask who will bill it, whether the location is covered and how results will reach your treating clinician. Review Medicare’s sleep-study coverage. If you have Medicare Advantage, check the plan’s network and any authorization rules as well.
The initial trial
What Continued CPAP Coverage Requires
Medicare may cover an initial 12-week CPAP trial for qualifying obstructive sleep apnea. Continued payment requires an in-person clinical reassessment and documentation that treatment is beneficial, along with the applicable usage requirements.
The Medicare equipment coverage policy specifies reassessment between days 31 and 91 after starting therapy. It defines adherence as at least four hours per night on 70% of nights during a consecutive 30-day period within the first three months. These are payment-documentation requirements, not advice to limit treatment to that amount. Follow your clinician’s prescribed use.
Ask the supplier how it records use and sends that information to the clinician. If you struggle with fit, leaks or discomfort, contact your treating team promptly rather than waiting until the end of the trial.
Read the Medicare PAP-device coverage policy for the full conditions. A different device or clinical situation may use different rules.
Before accepting equipment
Check Suppliers, Rental Terms and Cost Sharing
Under Original Medicare, the prescribing provider and equipment supplier must be enrolled in Medicare. Ask whether the supplier accepts assignment for the entire rental. After the Part B deductible, the usual share is 20% of the Medicare-approved amount; supplemental coverage may change what you owe.
For a qualifying CPAP rental, Medicare pays monthly for 13 continuous months of use, after which you own the machine. Confirm what happens if use stops, the supplier changes or your coverage changes. If you had a machine before Medicare, ask which records are needed for a covered rental, replacement or supplies.
See Medicare’s CPAP coverage page and our DME overview.
Masks and other supplies
Do Not Assume Every Shipment Is Covered
Ask the supplier which mask, tubing, filters and other supplies are covered, whether you need a new order and when replacement is medically appropriate. A replacement schedule is not an instruction to accept supplies you do not need. Keep delivery records and compare them with your claims statements.
For Medicare Advantage, confirm the contracted supplier, authorization and cost sharing with the specific plan. Original Medicare’s dollar share is not necessarily your plan’s copayment. Use the network-checking guide as a starting point.
Common questions
CPAP Coverage FAQ
Is every sleep-apnea device covered under the CPAP rules?
No. Different devices and treatments can have different coverage requirements. Ask your clinician and supplier about the exact prescribed item and billing code.
What if I miss the follow-up or do not meet the use requirement?
Contact the supplier and clinician immediately to find out what documentation is missing and whether a new evaluation is needed. Do not assume continued rental payments will be approved.
What should I do about a denial or unexpected supplier bill?
Request the claim explanation, billed item and reason for denial. Compare the supplier’s records with your coverage requirements and keep appeal deadlines. Our claims and appeals guide can help you organize the next steps.
Official information
Sources and Further Reading
Sources checked September 10, 2026.
Independent Medicare guidance
Check Your Plan’s Equipment Coverage
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Thompson Medicare Brokerage is not connected with or endorsed by the U.S. government or the federal Medicare program. This educational guide does not replace an official coverage or eligibility determination. Your circumstances and current Medicare and plan rules control.