CareFirst Blue Cross Blue Shield District of Columbia – CPAP Coverage
Great News – Health Sqyre Is in-Network With CareFirst BCBS of District of Columbia!
Health Sqyre has DME providers that are in-network with CareFirst Blue Cross Blue Shield of District of Columbia. If you are a sleep apnea patient, you can easily purchase your CPAP supplies online with us using your health insurance!
CareFirst BCBS of District of Columbia CPAP Therapy Policy Highlights
CareFirst Blue Cross Blue Shield of District of Columbia’s medical policies can be confusing, when it comes to treating sleep disorders. That’s why we’ve compiled all the information you need about your CPAP insurance coverage under your current health insurance plan.
1. Does CareFirst Blue Cross Blue Shield Cover Health Care Supplies Needed For CPAP Therapy?
Yes. Most all CareFirst Blue Cross Blue Shield PPO and HMO plans cover CPAP therapy supplies. This means that if you’re close to meeting your deductible, you may be eligible to buy your supplies with us at almost zero-cost!
2. Is Home Sleep Testing Covered?
Yes, CareFirst Blue Cross Blue Shield of District of Columbia covers and accepts a variety of home sleep tests. However, Health Sqyre does not offer home sleep tests through insurance at this time.
3. What CPAP Therapy Supplies Are Covered?
4. What CPAP Therapy Supplies Are NOT Covered?
In general, CareFirst Blue Cross Blue Shield considers convenience items and duplicate equipment not medically necessary and thus does not cover them. Hence, the durable medical equipment not covered by your benefit plan include:
- Cleaning supplies such as Mask wipes and cleaning machines, like the SoClean 2 or Lumin CPAP Cleaner.
- Duplicate equipment (Travel CPAP’s)
5. Does CareFirst Blue Cross Blue Shield of District of Columbia Require Compliance / Adherence For CPAP Therapy?
Yes. CareFirst Blue Cross Blue Shield of District of Columbia 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.
6. Is Documentation Required To Get Supplies Covered?
Yes, CareFirst Blue Cross Blue Shield of District of Columbia requires documentation to cover CPAP therapy supplies. This documentation includes relevant doctor’s notes, sleep test results, a prescription, among other items.
7. How Often Will CareFirst 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
CareFirst Blue Cross Blue Shield of District of Columbia – Reimbursement Schedule
|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|
CareFirst Blue Cross Blue Shield of District of Columbia – Customer Service Information
Want to Pay Another Way?
Paying with Cash
You can always pay out-of-pocket with Health Sqyre. Just browse our selection of CPAP supplies, click on a product, and you’ll see your cash price.
Paying with Medicare
Health Sqyre works with approved Medicare providers in every state, as well as many Medicare Advantage health plans nationwide.
Paying with FSA/HSA
You can use a flexible spending account (FSA) or a health savings account (HSA) to purchase most CPAP equipment as long as your FSA or HSA card is affiliated with a major credit card.
Out of Network Providers
Most insurance carriers allow direct reimbursement for cash purchases – just submit your receipt with a claim form, usually available through your insurance company’s member portal.
Have Questions? We’re Here to Help.
Our dedicated customer support team is available to answer any questions you may have and guide you through your shopping experience:
Live Chat: Every day, 8am – 5pm (MT)
Call: Monday – Friday, 8am – 5pm (MT) at 800-817-7118