Is CPAP Considered Durable Medical Equipment?

Is DME covered by insurance?

CPAP machines and supplies are considered durable medical equipment. That means they may be covered by your health insurance. However, this coverage will vary by state, as well as provider. 

What Is DME or Durable Medical Equipment

Durable medical equipment, or DME, includes equipment and supplies authorized by your doctor for at-home treatment of medical conditions. Some DME may be for a short-term injury or illness, such as crutches for a broken leg. Other DME can be used to treat long-term chronic conditions, such as CPAP machines for sleep apnea.

What Are the Items That Fall Under the DME Category? 

Durable medical equipment includes, but is not limited to: CPAP machines, oxygen concentrators, nebulizers, and other respiratory supplies. These are just some of the items on a long list of equipment that meets the criteria of DME.

CPAP Machine 

A CPAP machine may include traditional CPAP machines, BIPAP machines or auto CPAP machines, depending on your needs and your doctor’s prescription. Some portable CPAP machines may not be covered by health insurance as they are more for convenience than treatment. Choose a CPAP machine that helps you best with managing your sleep apnea.  

CPAP Tubing 

CPAP tubing can vary by length depending on how much flexibility you need during your CPAP therapy. Tubing is also one of the many supplies that regularly needs to be replaced. CPAP tubing over time can develop cracks and fissures and can lead to less effective therapy. Replacement CPAP tubing is considered one of the many items under DME supplies.  

CPAP Mask 

Your CPAP mask choice is usually based on your personal comfort. You can try different types of CPAP masks to see which one works best. Full face CPAP masks, nasal CPAP masks and nasal pillow CPAP masks are all considered DME supplies. They also will need to be replaced over time as they wear out.  

Headgear  

Headgear is essential for keeping your CPAP mask in place during therapy. Usually headgear is included with many CPAP mask purchases. You will want a CPAP headgear that is comfortable and is easily adjustable to fit your head shape and size. Like most CPAP supplies, headgear will need to be replaced when it no longer maintains a strong seal.  

Chin Support 

Chin supports are an optional choice for CPAP users. The chin support can help maintain comfort in conjunction with the mask and headgear. Often chin supports are not included with your CPAP mask purchase and must be ordered separately. If you experience discomfort during CPAP without a chin support, it is an accessory that may help as an optional CPAP DME supply.  

Is CPAP Considered Durable Medical Equipment? 

CPAP is considered durable medical equipment because it is used to treat sleep apnea and requires a prescription from a doctor. But you must maintain CPAP compliance in order to order new supplies. You may have to prove to your insurer that you continuously need and use your CPAP equipment to retain coverage. 

Your ability to maintain and adequately use your equipment—something referred to as CPAP compliance—is critical to your success with therapy. Besides benefiting your sleep health, your ability to be compliant shows insurance and Medicare payers you are using and replenishing your equipment adequately for the purpose of getting better. 

Will My Insurance Cover DME?

Generally, Medicare and Medicaid provide DME coverage. Medicare provides a list of covered DME, including CPAP machines, on their website. In addition, Medicare offers rules and requirements for coverage. For instance, your DME supplier must enroll in Medicare for you to receive coverage. 

Private health insurance companies are not required to cover DME, so it’s important to check coverage with your provider. While they may cover DME, your particular plan may only cover certain items or provide only partial coverage. It is important to answer all of these questions prior to purchasing your equipment.

Prior to receiving your equipment, the insurance company will need you to provide a valid prescription from a licensed physician. Online retailers who don’t work with insurance companies, such as The CPAP Shop, still require a prescription to purchase equipment.

How to Get the Full Benefit of Your Durable Medical Equipment Supplier? 

“SOS” Calls 

The durable medical equipment exists to help you succeed with your PAP therapy. You may find that you are struggling with your pressure settings or have a head cold, or allergies and CPAP therapy has become intolerable, or you dislike your CPAP mask or find you take it off more than you keep it on. For any of these reasons, you are encouraged to contact them to help you when you have CPAP problems. 

CPAP Education 

Perhaps one of the most important resources to an OSA patient is their resident DME provider, who is typically a PAP educator. 

This means they not only set you up with your medical equipment and supplies, but they teach you how to use your devices, help you to find ways to adjust to therapy even days or weeks after starting it, and provide you with tips and tricks for making it work for you if you are having problems with CPAP. 

Supply Replenishment 

While the PAP machine itself should last several years, the rest of the parts have limited life due to normal wear and tear. Your DME is prepared to help keep your CPAP masks, tubing, and CPAP filters up to date. 

With some DME providers, you can even set up automated messages in email to remind you to replace certain CPAP supplies that are expected to have worn out. 

Also, if you have a defective machine, the DME can replace it for you, preset with your custom prescription settings. 

Where Can I Buy DME?

Durable medical equipment suppliers offer DME, such as CPAP equipment, online and through their supply stores. Some suppliers may even rent you equipment if your needs are only for short-term treatment, such as recovering from surgery.

Why Buy from Us?

The CPAP Shop is a safe, reliable, and convenient provider of DME for managing sleep apnea, as well as other respiratory illnesses. Our knowledgeable customer care team will help guide you to the highest quality CPAP equipment based on your prescription. While The CPAP Shop offers a retail location in West Berlin, NJ, we also provide patients with a complete online shopping experience, allowing you to purchase your equipment from the comfort of home.

For more information about The CPAP Shop visit us online at www.thecpapshop.com. If you have questions about the type of equipment we provide, feel free to call us at 866-414-9700 or email questions@thecpapshop.com.

Chris Vasta

Author

Chris Vasta

Over a 10+ year career at PHH Mortgage managing a $100 million portfolio, Chris Vasta learned the ins and outs of the business world. He learned how to establish business relationships, lead a multi-prong team, and implement strategies for long-term growth. In 2007, Vasta used that experience to transition his role into president of The CPAP Shop. Over his tenure, Vasta has been involved in everything from website design to warehouse layout. His hands-on approach with customers has evolved into an in-depth understanding of the challenges of beginning and adhering to sleep therapy. He often provides his insights on product…


4 Comments Leave new

  • DAVID CHARLES SEIGFREID

    the power supply for my Phillips machine stooped last night. can you tell me if I can get a new one thru my Aetna medical insurance?

    • Chris Vasta

      Hi David, we do not work directly with insurance companies so you would have to reach out independently to them.

  • Leslie Lety

    Mask I ordered before had soft foam
    Mask I got from you was soft plastic.

    • Chris Vasta

      Hello, Leslie. The ResMed Airfit N20 and Airfit F20 are both offered with either a clear silicone cushion or a gray memory foam cushion. When it has the memory foam cushion it is called the Air Touch cushion. For assistance please call our customer service team at 1-866-414-9700.

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