Blue Cross Blue Shield Michigan CPAP Therapy Policy
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 Blue Cross Blue Shield Michigan 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
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