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

Medicare covers PAP devices (E0601 and E0470 for OSA) when a pre-test in-person clinical evaluation is documented and a valid, FDA‑approved sleep test meets Medicare AHI/RDI thresholds (AHI/RDI >=15 with >=30 events, or 5–14 with >=10 events plus specified symptoms or comorbidities). Continued coverage requires re-evaluation between days 31–91 and objective adherence (>=4 hours/night on >=70% nights during a consecutive 30‑day period within the first 3 months); E0470 requires prior documented failure of E0601. Accessories, refills, replacements, and concurrent oxygen have specific documentation, quantity, timing, and provider-ordering requirements; missing SWO/WOPD, POD, or other required documentation will result in denial.

"A single-level CPAP device (E0601) is covered for obstructive sleep apnea (OSA) when the beneficiary has an in-person clinical evaluation by the treating practitioner prior to the sleep test."