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Your Guide to Getting New PAP Supplies:Staying Compliant and Getting the Most Out of Your Therapy.

You count on your PAP equipment to help you sleep better and feel better. To keep your therapy working the way it should, it’s important to replace supplies regularly—like masks, cushions, and filters—so everything stays in good condition. This guide explains how coverage works and the steps you need to take to ensure you qualify for new supplies and devices through your insurance plan including Medicare and Medicaid in the states we serve.

What you need to know

  • Most insurance plans—including HMOs, PPOs, Medicare, and Medicaid—cover equipment such as PAP devices, oxygen, and ventilators.
  • To keep coverage, insurers may have rules you need to follow, such as showing you’re using your equipment as prescribed by your health care provider.
  • Some devices automatically track your usage and send that information to your supplier.
  • Some insurers, including Medicare, may require follow-up visits with your provider to confirm your treatment is still effective and medically necessary.
  • Always check with your insurance company to understand their specific requirements. If you don’t meet required usage or follow-up visit guidelines, you may be responsible for paying for your equipment out of pocket.

How We Support You

  • Follow up with you to see how you are doing and answer your questions.
  • Arrange for a mask refit if you are having difficulty with your interface, mask, or equipment.
  • Be available to answer your questions, make suggestions, and provide coaching every step of the way.
  • Our Patient Portal gives you safe, 24/7 access to your billing information so you can stay organized and in control of your payments. Your information is handled through secure systems and we’re committed to protecting your data at every step. To login or register, visit our Patient Portal 
  • Our patients can reorder insurance-covered supplies easily through our Reorder Supplies Portal. We also offer Scheduled Shipping for automatic deliveries based on your insurance schedule.

Click the links below to see the guidelines for your state and other resources to help you keep your therapy on track.

Medicare and Medicaid, as well as most insurance plans, have adopted the following PAP compliance guidelines, which must be met during the initial 90-day “trial” period to qualify for continued use or purchase after the first three months of use.

In the first 90 days, you must have at least one (1) documented* consecutive 30-day period where you used the PAP device for at least 4 hours per night for 21 of those 30 nights.

PLUS

You must have a face-to-face clinical re-evaluation by your doctor between the 31st and 91st day. Your doctor must document the following in chart notes:

  • That your symptoms of sleep apnea have improved, and
  • That the objective evidence – actual use data from your equipment – of PAP compliance has been reviewed and placed in your medical record.

Once you have met all these requirements, insurance will resume payment for the rental and/or purchase of the PAP equipment and future replacement supplies when needed as long as you continue to be benefit-eligible. It is important to note that some insurance plans may require additional compliance verification even after the initial 90-day compliance period is over.

PAP Compliance Guidelines – Medicare & Medicaid 

 

Medicare 

Medicaid 

Requirements Overview 

If you do not meet the requirements exactly, Medicare compliance requires that equipment is returned to the supplier or that you pay privately for the equipment and future replacement supplies.  

 

If you do not meet these requirements exactly, Medicaid requires that equipment is returned to the supplier immediately.  

To try PAP therapy again 

Your physician must prescribe another sleep study (at sleep lab) and you must begin another PAP compliance trial period. 

Your physician and Medicaid must determine if a new sleep study is appropriate by understanding your compliance issues. If appropriate, your physician will determine the next steps and work with your supplier to assist you. 

Medicare, Medicaid, and private insurance plans cover the regular replacement of PAP supplies. With daily use, supplies naturally wear out over time even if you don’t notice the difference until after they’ve been replaced. Replacing supplies is important for comfort, compliance, and cleanliness. Medicare and Medicaid allow replacement at the following maximum frequency:

Item 

Medicare & Medicaid

  

Nasal mask 

1 per 3 months 

  

Replacement nasal cushion/pillow 

2 per 1 month 

  

Full face mask 

1 per 3 months 

  

Replacement full face cushion 

1 per 1 month 

  

Tubing 

 1 per 3 months 

  

Headgear 

1 per 6 months 

  

Chinstrap 

1 per 6 months 

  

Disposable filter 

2 per 1 month 

  

Washable filter 

 1 per 6 months 

  

Water chamber 

1 per 6 months 

  

Note: Medicaid does not provide 90-day refills. Supplies will follow the above refill schedule. 

We know that not all items are covered by insurance, which is why our online store offers retail options to support your therapy and overall wellness. Our store is ideal for travel, backup, or convenience purchases—with easy online ordering and fast shipping.

Visit https://shop.performancehomemed.com to explore available options.

Medicare, Medicaid, and private insurance plans cover the regular replacement of PAP supplies. With daily use, supplies naturally wear out over time even if you don’t notice the difference until after they’ve been replaced. Replacing supplies is important for comfort, compliance, and cleanliness. Medicare and Medicaid allow replacement at the following maximum frequency:

Item 

Medicare & Medicaid 

  

Nasal mask 

1 per 3 months 

  

Replacement nasal cushion/pillow 

2 per 1 month 

  

Full face mask 

1 per 3 months 

  

Replacement full face cushion 

1 per 1 month 

  

Tubing 

1 per 3 months 

  

Headgear 

1 per 6 months 

  

Chinstrap 

1 per 6 months 

  

Disposable filter 

2 per 1 month 

  

Washable filter 

 1 per 6 months 

  

Water chamber 

1 per 6 months 

  

Note: Medicaid does not provide 90-day refills. Supplies will follow the above refill schedule.

We know that not all items are covered by insurance, which is why our online store offers retail options to support your therapy and overall wellness. Our store is ideal for travel, backup, or convenience purchases—with easy online ordering and fast shipping.

Visit https://shop.performancehomemed.com to explore available options.

Medicare, Medicaid, and private insurance plans cover the regular replacement of PAP supplies. With daily use, supplies naturally wear out over time even if you don’t notice the difference until after they’ve been replaced. Replacing supplies is important for comfort, compliance, and cleanliness. Medicare and Medicaid allow replacement at the following maximum frequency:

Item 

Medicare 

Medicaid 

Nasal mask 

1 per 3 months 

1 per 6 months 

Replacement nasal cushion/pillow 

2 per 1 month 

1 per 3 months 

Full face mask 

1 per 3 months 

1 per 6 months 

Replacement full face cushion 

1 per 1 month 

1 per 3 months 

Tubing 

1 per 3 months 

1 per 6 months 

Headgear 

1 per 6 months 

1 per 6 months 

Chinstrap 

1 per 6 months 

1 per 6 months 

Disposable filter 

2 per 1 month 

2 per 1 month 

Washable filter 

1 per 6 months 

 1 per 6 months 

Water chamber 

1 per 6 months 

1 per 6 months 

We know that not all items are covered by insurance, which is why our online store offers retail options to support your therapy and overall wellness. Our store is ideal for travel, backup, or convenience purchases—with easy online ordering and fast shipping.

Visit https://shop.performancehomemed.com to explore available options.

Thank you for choosing Perform Health

We’re honored to provide excellent care and one-on-one support every step of the way.

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