Aetna CPAP Therapy Policy

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Aetna CPAP Therapy Policy Highlights

Does Aetna cover supplies needed for CPAP therapy?

  • Yes.  Most all Aetna plans cover CPAP therapy supplies.

Is home sleep testing covered?

  • Yes, Aetna covers and accepts a variety of home sleep tests.

What CPAP therapy supplies are covered?

What CPAP therapy supplies are NOT covered?

  • In general, Aetna considers convenience items and duplicate equipment not medically necessary and thus does not cover them. They include:
    • Cleaning supplies such as mask wipes and cleaning machines like the SoClean
    • Batteries
    • Duplicate equipment (travel CPAP’s)

Does Aetna require compliance / adherence for CPAP therapy?

  • Yes.  Aetna requires adherence and will only cover a medically necessary PAP device beyond the first three months of therapy when PAP use is greater than or equal to 4 hours per night on 70% of nights during a consecutive 30 day period during the first three months of therapy.

Is documentation required to get supplies covered?

  • Yes, Aetna requires documentation to cover CPAP therapy supplies.  This documentation includes relevant doctor’s notes, sleep test results, a prescription, among other items.

How often will Aetna replace my CPAP supplies?

  • A comprehensive replacement schedule can be found further below:
    • Typically, filter replacements are every 30 days
    • Typically, tubing replacements are every 3 months
    • Typically, mask replacements are every 3 months
    • Typically, machines are every 5 years

Detailed Aetna Reimbursement Schedule

Code Description

CPAP HCPCS

Usual Maximum

Heated TubingA46041 per 3 months
Hybrid MaskA70271 per 3 months
Replacement Hybrid Mask CushionA70282 per 1 month
Replacement Hybrid Mask Nasal PillowA70292 per 1 month
Full Face MaskA70301 per 3 months
Replacement Full Face Mask CushionA70311 per 1 month
Replacement Nasal Mask CushionA70322 per 1 month
Replacement Nasal PillowA70332 per 1 month
Nasal Pillow MaskA70341 per 3 months
HeadgearA70351 per 6 months
ChinstrapA70361 per 6 months
TubingA70371 per 3 months
Disposable FilterA70382 per 1 month
Non-disposable FilterA70391 per 6 months
Oral Interface MaskA70441 per 3 months
Replacement Humidifier ChamberA70461 per 6 months
BiPAP MachineE04701 per 5 years
BiPAP Auto MachineE04711 per 5 years
Non-heated CPAP HumidifierE05611 per 5 years
Heated CPAP HumidifierE05621 per 5 years
CPAP MachineE06011 per 5 years

Aetna – Customer Service Information

1-800-872-3862

Aetna’s CPAP Therapy Medical Coverage Policy

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