Anthem Blue Cross and Blue Shield Wisconsin CPAP Therapy Policy

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Blue Cross Blue Shield CPAP Therapy Policy Highlights

Does Blue Cross Blue Shield cover supplies needed for CPAP therapy?

  • Yes.  Most all Blue Cross Blue Shield plans cover CPAP therapy supplies.

Is home sleep testing covered?

  • Yes, Blue Cross Blue Shield covers and accepts a variety of home sleep tests.

What CPAP therapy supplies are covered?

What CPAP therapy supplies are NOT covered?

  • In general, Blue Cross Blue Shield 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 Blue Cross Blue Shield require compliance / adherence for CPAP therapy?

  • Yes.  Blue Cross Blue Shield 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, Blue Cross Blue Shield 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 Blue Cross Blue Shield 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 Anthem Blue Cross Blue Shield Wisconsin 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

Blue Cross Blue Shield – Customer Service Information

Customer Service Number of Anthem BCBS Wisconsin

 

Anthem Blue Cross Blue Shield Wisconsin FAQs

Health Sqyre Works with Blue Cross Blue Shield Patients

Health Sqyre can get your coverage information in real-time and has providers that are in-network with Anthem Blue Cross Blue Shield Wisconsin so that you can easily purchase your supplies using your insurance all online…  Try it now!

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