CPAP Prescription: Understanding Your Doctor’s Letter and Insurance Coverage

A CPAP machine requires a prescription because it’s a Class II medical device. Insurance (including Medicare) typically covers it only with a valid prescription and documented medical necessity.

Getting a Prescription

1. Clinical evaluation: Symptoms such as snoring, witnessed apneas, and daytime sleepiness.
2. Sleep study: In‑lab polysomnography or home sleep apnea test (HSAT) confirming obstructive sleep apnea (AHI ≥5 or ≥15 with symptoms).
3. Diagnosis and prescription: A physician (sleep specialist, pulmonologist, ENT, or primary care) writes the Rx with pressure settings, mask type, and humidifier specifications.

Insurance Requirements

• Compliance data download (often a 30‑day trial: ≥4 hours/night on 70% of nights).
• Face‑to‑face visit documented (Medicare).
• DME supplier must be in‑network.

Tips for Your Doctor Visit

• Bring sleep study results, a symptom log, and your Epworth Sleepiness Scale score.
• Ask for mask‑fitting guidance or a referral to a DME for a trial.
• Request documentation of medical necessity for appeals if denied.

If You’re Uninsured

• Manufacturer assistance programs (ResMed, Philips).
• Non‑profits (ASAA, local charities).
• Refurbished or used machines (verify pressure accuracy and hygiene).

Consistent CPAP use improves sleep, cognition, cardiovascular risk, and quality of life. Work with your care team to optimize therapy.