Medicare · National

Medicare

Medicare publishes coverage policies for 4 of the 4 sleep apnea treatments we track. Each is linked to its source document below.

By treatment

CPAP and PAP therapy

Policy published

Prior authorization Not researched

Initial qualification Required

Continued coverage Required

Utilization management Not required

Policy number — NCD 240.4

Effective — 2008-03-13

Before treatment starts

Initial qualification

In-person clinical evaluation by the treating practitioner before the sleep test.
Sleep testing must be ordered by the treating practitioner and meet Medicare testing rules.
AHI/RDI must meet Medicare thresholds, including the required event count and qualifying symptoms when applicable.
The supplier must instruct the beneficiary or caregiver on proper PAP use and care.

Primary coverage source → · Plain-language explanation →

After treatment starts

Continued coverage

Clinical re-evaluation between days 31 and 91 must document that PAP symptoms improved.
Objective use must show at least 4 hours/night on 70% of nights in one consecutive 30-day period during the first 3 months.
A late re-evaluation can restart coverage from that visit once benefit and adherence are documented.
After a failed initial 12-week trial, requalification requires in-person re-evaluation and a repeat facility-based Type 1 sleep study.

Primary coverage source → · Plain-language explanation →

Read the policy document →

Oral appliance therapy

Policy published

Prior authorization Not researched

Initial qualification Not researched

Continued coverage Not researched

Utilization management Not required

Policy number — L33611

Effective — 2020-01-01

Read the policy document →

Hypoglossal nerve stimulation

Policy published

Prior authorization Not researched

Initial qualification Not researched

Continued coverage Not researched

Utilization management Required

Policy number — L38276

Effective — 2026-05-14

Published utilization-management detail

Documented CPAP failure despite optimization or documented CPAP intolerance

Read the policy document →

Tirzepatide (Zepbound) for OSA

Policy published

Prior authorization Not researched

Initial qualification Not researched

Continued coverage Not researched

Utilization management Not researched

Read the policy document →

Last verified 2026-08-15. We record structured facts and link the source; we do not reproduce policy text. The document itself governs.

If you're denied

Medicare publishes its own appeal instructions. Start there, and note the deadline on your denial letter.

Medicare appeals process

How to appeal a sleep apnea denial →

Your specific plan may differ from Medicare's general policy, particularly if your coverage is through an employer. Policies are revised without notice. Nothing here is a guarantee of coverage or a substitute for confirming with your plan.