CPAP Prescription Requirements

The Prescription
A physician must write a prescription for CPAP & Supplies prior to delivery. Also necessary is Diagnosis, and length of need. A written prescription is required prior to delivery.

Insurance Requirements

Medicare, Medicaid, and Commercial Insurance

Certain insurance polices may pay for your CPAP & Supplies, but payment is based on Sleep Study, diagnosis, and other information. The information listed below will help you to determine insurance coverage.

Medicare – In addition to a prescription, Medicare requires a current Sleep Study preformed by an accredited Sleep Lab. CPAP requirements are as follows;

• Complete description of equipment & supplies
• Length of need
• Diagnosis, such as Obstructive Sleep Apnea
• Current Sleep Study
• Physicians Signature
• Date

Third Party Insurances- All third party insurances require a prescription as described above. Requirements for CPAP & supplies are different for each insurance plan. We will contact your insurance company for you and request benefit coverage, and obtain prior authorization if needed.

Mass Health – CPAP & Supplies is a Prior- Authorization item and can take up to 4 weeks for approval. Prescriptions must be within 30 days of the initial date of request, and written on the physicians prescription pad or letterhead. CPAP may be authorized for 3 months and renewal documentation for authorization must show compliance. A Sleep Study done at an accredited lab is also required. The prescription requirements are very strict and must contain the following information written on the physicians prescription pad;

• The recipients name, address and MassHealth number
• The CPAP & Supplies requested
• The diagnosis associated with the prescribed therapy
• Specific therapeutic objectives
• The estimated length of time that the equipment will be used
• The prescriber’s address and telephone number
• Signature and date of the prescribe

BiLevel Prescription Requirements

The Prescription
A physician must write a prescription for Bi-Level & Supplies prior to delivery. Also necessary is Diagnosis, and length of need. A written prescription is required prior to delivery.

Insurance Requirements

Medicare, Medicaid, and Commercial Insurance

Certain insurance polices may pay for your Bi-Level & Supplies, but payment is based on Sleep Study, diagnosis, and other information. The information listed below will help you to determine insurance coverage.

Medicare – In addition to a prescription, Medicare requires a current Sleep Study preformed by an accredited Sleep Lab. Bi-Level requirements are as follows;

Complete description of equipment & supplies

Length of need

Diagnosis, such as Obstructive Sleep Apnea

Current Sleep Study

Physicians Signature

Date

Third Party Insurances- All third