Blue Cross Blue Shield Georgia 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 Georgia Reimbursement Schedule

Code Description

CPAP HCPCS

Usual Maximum

Heated Tubing A4604 1 per 3 months
Hybrid Mask A7027 1 per 3 months
Replacement Hybrid Mask Cushion A7028 2 per 1 month
Replacement Hybrid Mask Nasal Pillow A7029 2 per 1 month
Full Face Mask A7030 1 per 3 months
Replacement Full Face Mask Cushion A7031 1 per 1 month
Replacement Nasal Mask Cushion A7032 2 per 1 month
Replacement Nasal Pillow A7033 2 per 1 month
Nasal Pillow Mask A7034 1 per 3 months
Headgear A7035 1 per 6 months
Chinstrap A7036 1 per 6 months
Tubing A7037 1 per 3 months
Disposable Filter A7038 2 per 1 month
Non-disposable Filter A7039 1 per 6 months
Oral Interface Mask A7044 1 per 3 months
Replacement Humidifier Chamber A7046 1 per 6 months
BiPAP Machine E0470 1 per 5 years
BiPAP Auto Machine E0471 1 per 5 years
Non-heated CPAP Humidifier E0561 1 per 5 years
Heated CPAP Humidifier E0562 1 per 5 years
CPAP Machine E0601 1 per 5 years

Blue Cross Blue Shield – Customer Service Information

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 Georgia so that you can easily purchase your supplies using your insurance all online…  Try it now!

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