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CPAP Masks and Accessories Replacement Schedule

The bottom line is that replacement frequency of CPAP supplies differs by person, care and product. Your needs are not necessarily related to what your insurance company will provide for you. Good care of the equipment and accessories will certainly extend their life, but it is not purely a matter of cleaning, as facial oils and general usage will also impact supplies. Even if some of the equipment looks clean it still may be worn down from frequent usage which can lead to CPAP side effects. Some product manufacturers recommend more frequent replacement of key CPAP supplies, particularly of pillows and cushions. You will need to proactively manage your condition based on product manufacturer recommendations, doctors' guidance and how it feels to you.

Insurance companies recognize that providing for replacement of new CPAP supplies frequently will keep your equipment working properly and reduce significant health conditions from untreated use - see Is Sleep Apnea Fatal? to understand the most dire ramifications of non-compliant treatment. Though every insurance company is different, they typically follow the Medicare reimbursement schedule. Below is the general schedule from Medicare.

DME MACs’ Determination of Reasonable and Necessary Replacement of CPAP Supplies

HCPCS Code Description Frequency
A4604 CPAP Tubing With Heating Element 1 per 3 months
A7027 Combination Oral/Nasal CPAP Mask 1 per 3 months
A7028 Replacement Oral Cushion for Oral/Nasal Mask 2 per 1 month
A7029 Replacement Nasal Pillows for Oral/Nasal Mask, One Pair 2 per 1 month
A7030 Full Face Mask 1 per 3 months
A7031 Full Face Mask Interface 1 per 1 month
A7032 Cushion for Nasal Mask Interface 2 per 1 month
A7033 Nasal Pillows 2 per 1 month
A7034 Nasal Interface 1 per 3 months
A7035 Headgear 1 per 6 months
A7036 Chinstrap 1 per 6 months
A7037 Tubing 1 per 3 months
A7038 Disposable Filter 2 per 1 month
A7039 Nondisposable Filter 1 per 6 months
A7046 Humidifier Water Chamber 1 per 6 months

Source

DME MAC LCDs: CIGNA Government Services (L11518) dated February 4, 2011; National Government Services (L27230) dated October 1, 2011; National Heritage Insurance Company (L11504) dated February 4, 2011; Noridian Administrative Services (L171) dated October 1, 2011.