Regence BlueShield of Washington 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

Regence BlueShield of Washington Reimbursement Schedule

Code Description


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

Customer Service Number of BCBS of Washington


Regence Blue Shield of Washington CPAP Therapy Medical Coverage Policy

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 Regence BlueShield of Washington so that you can easily purchase your supplies using your insurance all online…  Try it now!

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