Highmark Blue Shield of Pennsylvania 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?
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
- 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 Highmark Blue Shield of Pennsylvania 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|
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 Highmark Blue Shield of Pennsylvania so that you can easily purchase your supplies using your insurance all online… Try it now!