Blue Cross Blue Shield Illinois CPAP Therapy Policy
Health Sqyre allows patients to buy CPAP supplies on an in-network basis using your Blue Cross Blue Shield of Illinois insurance. You will have the ability to compare cash prices vs. insurance prices to make the best financial decision based on where you are in your current plan.
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?
- Blue Cross Blue Shield covers most CPAP supplies including:
- Machines and humidifiers
- Masks and headgear
- Tubes and filters
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 Illinois 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 Illinois so that you can easily purchase your supplies using your insurance all online… Try it now!
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