CPAP Supply Replacement Schedule (Medicare)
Medicare limits how often it pays for replacement CPAP parts. The usual maximum quantities below come from the Medicare Local Coverage Determination for positive airway pressure devices (L33718). Many private insurers and suppliers use the same schedule. These are maximums Medicare will pay for, not a rule that you must replace each part on that date.
| HCPCS code | Item | Usual maximum quantity |
|---|---|---|
| A7030 | Full face mask | 1 every 3 months |
| A7031 | Full face mask cushion | 1 per month |
| A7034 | Nasal mask or nasal pillow interface (frame) | 1 every 3 months |
| A7032 | Nasal mask cushion | 2 per month |
| A7033 | Nasal pillows | 2 per month |
| A7027 | Oral/nasal combination mask | 1 every 3 months |
| A7028 | Oral cushion for combination mask | 2 per month |
| A7029 | Nasal pillows for combination mask | 2 per month |
| A7035 | Headgear | 1 every 6 months |
| A7036 | Chinstrap | 1 every 6 months |
| A7037 | Tubing | 1 every 3 months |
| A4604 | Tubing with integrated heating element | 1 every 3 months |
| A7038 | Filter, disposable | 2 per month |
| A7039 | Filter, non-disposable | 1 every 6 months |
| A7046 | Humidifier water chamber | 1 every 6 months |
Notes
- Quantities above the usual maximum are denied unless the policy allows otherwise.
- Replace any part sooner if it is torn, stiff, discolored or no longer sealing, and follow the manufacturer's cleaning advice.
- Medicare generally considers 5 years the reasonable useful lifetime of a CPAP or bilevel machine.
- Your plan may differ; check with your supplier.
Frequently asked questions
How often should I replace my CPAP mask cushion?
Medicare pays for up to one full face cushion per month and up to two nasal cushions or nasal pillow sets per month. Replace earlier if it leaks or is damaged.
How often should tubing be replaced?
Up to one standard or heated tube every 3 months under the Medicare schedule.
Can I wash filters instead of replacing them?
Reusable (non-disposable) filters are meant to be rinsed and replaced about every 6 months. Disposable filters should not be washed; Medicare allows up to 2 per month.
Sources
More reference tables
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