Continuous Positive Airway Pressure (CPAP) Machine
Philips recall: In 2021, Philips issued a voluntary recall of certain Respironics Sleep and Respiratory Care products. Visit the Philips website for details.
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Continuous Positive Airway Pressure (CPAP) machines also known as respiratory assist devices, are considered durable medical equipment (DME). All TRICARE Prime, TRICARE Prime Remote and TRICARE Young Adult Prime beneficiaries require an approval from Health Net Federal Services, LLC (HNFS). CPAP machines are a limited benefit and may be covered for the following:
- obstructive sleep apnea syndrome (OSA) or
- respiratory insufficiency
Active duty service members diagnosed with OSA may be authorized to receive a portable CPAP device if they travel for official business (for example, work travel) at least three days per month or are being deployed.
- The portable device must have humidification and battery capability.
- If the service member already has a standard CPAP device, a portable device may be authorized if the criteria are met. However, once the service member has been authorized to receive a portable CPAP device, he or she won’t be eligible to receive a standard CPAP device in the future.
Replacement supplies, such as an oral/nasal mask, nasal pillows or a face mask interface, do not require an approval from HNFS. (Check the CMS DMEPOS Fee Schedule for additional information.) See also the certificate of medical necessity requirements on our DME benefit page.
Variable Positive Airway Pressure (VPAP) or Adaptive Servo-Ventilation (ASV) machines and Intraoral Pressure Gradient devices (also known as WINX devices) are considered unproven and are not covered benefits.
Cost Information
