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What Compliance Entails

Patients have the option to purchase new CPAP machines and supplies as self-pay or you can qualify through insurance for your CPAP equipment. Insurance plans have specific CPAP compliance requirements.  You will need to meet the insurance provider requirements. will work with you to select great equipment and to ensure that you meet your insurance compliance requirements.

Insurance and CPAP Compliance

Many commercial plans and Medicaid plans do not require any CPAP compliance but may require specific documentation upfront before approving a new CPAP machine.  Commercial insurance plans like Blue Cross Blue Shield, Cigna and Coventry will require the patient to prove usage rate for a minimum of 70% over a 30 to 90-day timeframe.

You can break down the 70% usage rate at a minimum of 4 hours a night for at least 5 days a week. We encourage our patients to use their CPAP machines nightly to receive the most benefits from the treatment.  This usage requirement is proven with a CPAP download.  Depending on the machine you select, you will be able to use SD cards or a wireless modem to send the data to  Our compliance representative will review your data and submit it to your insurance plan for you.

The AirSense S10 CPAP machine from Resmed comes with a built-in modem that will easily transmit your usage data.  If your machine does not have an internal modem, it will come with an SD card. You can mail the SD Card back to us.

Medicare and CPAP Compliance

If you have Medicare, you will follow a more strenuous CPAP compliance requirements.  Coverage for durable medical equipment like CPAP machines falls under Medicare Part B.

Your Medicare doctor can prescribe CPAP therapy for a three-month trial after sleep study confirms obstructive sleep apnea.

During this trial, Medicare requires that your usage meets a minimum of 70% over a 30 consecutive-day timeframe. You must achieve this usage within the first 90 days. Medicare also requires a follow-up appointment with the physician.  This appointment must be no earlier than 31 days after your set update and no later than 90 days. If this therapy benefits you, then Medicare may continue to provide coverage for your CPAP machine and its supplies.  

There are no compliance requirements for Medigap insurance policies. If Medicare approves coverage and pays its share, your Medigap policy will pay its share as well.

We submit a copy of the notes from this appointment must be sent to them to submit to Medicare.  Our staff will work closely with you to help you meet these requirements. If you are planning to get a new CPAP machine and are not sure if your insurance has requirements for compliance, contact for assistance.

If you have more detailed questions about your machine and adjusting to therapy, submit your question to one of our certified CPAP clinicians for tips and help on succeeding with your CPAP therapy.

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