If you or someone you love has been told that a CPAP machine isn't enough, you may be wondering whether Medicare will cover a BiPAP device instead. The short answer: yes, Medicare Part B does cover BiPAP machines — but there are specific requirements you need to meet, and the process works a bit differently than walking into a pharmacy. This guide breaks down exactly what Medicare covers, what you'll pay out of pocket, and what documentation your doctor needs to provide before a Medicare-enrolled supplier can set you up. ## What Is a BiPAP Machine? BiPAP stands for Bilevel Positive Airway Pressure. Unlike a CPAP machine, which delivers a single continuous stream of air pressure, a BiPAP has two separate pressure settings: a higher pressure when you inhale (IPAP) and a lower pressure when you exhale (EPAP). That distinction matters clinically. For patients who struggle to breathe out against constant CPAP pressure — or for those whose underlying condition requires different pressure support during inhalation and exhalation — a BiPAP is often the more appropriate choice. Common conditions where a BiPAP is prescribed instead of a CPAP include: - **Obesity hypoventilation syndrome (OHS)** - **COPD with overlap sleep apnea syndrome** - **Central sleep apnea or complex (mixed) sleep apnea** - **Neuromuscular diseases** affecting breathing - **CPAP intolerance** due to high required pressure settings ## How Medicare Classifies BiPAP Equipment Medicare Part B covers BiPAP machines as **Durable Medical Equipment (DME)** under two HCPCS codes: | Code | Device Type | |------|-------------| | **E0470** | BiPAP without backup rate | | **E0471** | BiPAP with backup rate (for central apnea or neuromuscular conditions) | Backup rate devices (E0471) add a feature that forces a breath if you stop breathing for a set interval — this is specifically for patients with central or mixed apnea patterns, not straightforward obstructive sleep apnea. Your sleep specialist or pulmonologist will determine which device is medically necessary and write the prescription accordingly. ## Medicare Coverage Requirements for BiPAP in 2026 Medicare doesn't automatically cover a BiPAP just because a doctor orders one. The coverage criteria are spelled out in the Local Coverage Determination (LCD) for respiratory assist devices, and you'll need to satisfy all of them. ### Step 1: A Qualifying Sleep Study You must have a **polysomnography (PSG)** — an in-lab overnight sleep study — or, in some cases, an approved Home Sleep Apnea Test (HSAT). The study must document: - An **Apnea-Hypopnea Index (AHI) of 5 or greater**, indicating at least mild sleep apnea - Clinical findings that support bilevel therapy over standard CPAP For E0471 (with backup rate), the study must also document central apnea events or a specific condition like Cheyne-Stokes respiration. ### Step 2: Medical Necessity Documentation Your treating physician must document **why** a BiPAP is medically necessary. This typically means one of the following is true: - A CPAP trial was attempted and failed (documented intolerance after a reasonable compliance period) - CPAP is clinically contraindicated given your diagnosis - Your AHI and clinical profile require bilevel support to adequately treat the condition If you're being prescribed an E0471 device, the documentation requirements are stricter — your physician must provide detailed evidence of the qualifying condition. ### Step 3: Face-to-Face Evaluation Medicare requires a **face-to-face clinical evaluation** with your treating physician before the equipment is ordered. Telehealth visits can satisfy this requirement in many circumstances, but your DME supplier will verify this was done. ### Step 4: A Written Prescription from a Medicare-Enrolled Provider The order must come from a physician, nurse practitioner, or physician assistant who is **enrolled in Medicare** and treating you for the condition requiring the device. ## What Does a BiPAP Cost Under Medicare in 2026? Medicare Part B covers 80% of the Medicare-approved amount after you've met your annual deductible, which is **$283 in 2026**. You pay the remaining 20%. **Rental model:** Medicare pays for BiPAP equipment under a **13-month rental arrangement**. During that time, your supplier maintains and services the equipment. After the 13th consecutive month of rental, ownership of the device transfers to you at no additional cost. **Supplies:** Masks, tubing, filters, and chin straps are covered on an ongoing basis as long as the equipment is medically necessary. Replacement schedules are standardized — Medicare sets specific frequencies for each supply item. **Heated humidifier:** If your physician prescribes a heated humidifier (HCPCS E0562) as part of your therapy setup, that's covered separately under Part B as well. If you have a **Medicare Supplement (Medigap)** plan, it typically covers your 20% coinsurance, leaving you with little to no out-of-pocket cost. If you're enrolled in a **Medicare Advantage** plan, coverage rules vary by plan — always call your plan's member services before getting equipment. You can compare Medicare Advantage DME coverage options on [DMEHelper's coverage guide](/dme-coverage/). ## The 3-Month Compliance Requirement This is where many patients get tripped up. Medicare doesn't simply pay for your device and walk away — it requires proof that you're actually using it. After your BiPAP is set up, your supplier will schedule a **follow-up clinical evaluation** within 31 to 91 days. During that window, you must have used the device for **at least 4 hours per night on 70% of nights** (measured over any consecutive 30-day period within the first 90 days). Your device records this data automatically. If you meet the compliance threshold, Medicare continues paying for the rental and supplies. If you don't, coverage can be terminated. **Practical tip:** If you're struggling to tolerate the device — pressure too high, mask leaks, dry mouth — call your supplier early. Mask adjustments, pressure changes, or switching to a different interface can make a significant difference, and your supplier should help before that compliance window closes. ## Getting a BiPAP Through a Medicare-Enrolled Supplier Not every DME supplier is enrolled in Medicare. Working with a supplier that **accepts Medicare assignment** means they agree to bill Medicare directly and only charge you the standard 20% coinsurance — they cannot balance-bill you. When you're searching for a supplier: - Ask whether they are a Medicare-enrolled, participating supplier - Confirm they carry the specific device your physician prescribed - Ask whether they provide in-home setup and education (this is standard for most BiPAP setups) - Find out how they handle resupply orders and what their turnaround time is If you need [CPAP equipment](/cpap-devices/), the qualification path is similar but somewhat simpler — BiPAP has stricter documentation requirements because it's a more complex device. **[Find Medicare-enrolled DME suppliers near you on DMEHelper →](/)** ## Frequently Asked Questions **Does Medicare cover BiPAP for COPD?** Yes. If you have COPD with overlap sleep apnea or obesity hypoventilation syndrome and your physician documents medical necessity for bilevel therapy, Medicare Part B can cover a BiPAP (E0470 or E0471 depending on your specific diagnosis). **Can I get a BiPAP if I already have a CPAP through Medicare?** Possibly. Medicare will cover a transition from CPAP to BiPAP if your physician documents that CPAP has failed or is no longer appropriate. You cannot simultaneously receive Medicare payment for both devices. **Does Medicare cover BiPAP supplies like masks and tubing?** Yes. Masks, tubing, filters, and other accessories are covered under the same DME benefit as long as the device itself remains medically necessary and you continue using it. **How long does Medicare cover a BiPAP rental?** Medicare covers a 13-month rental. After month 13, ownership of the device transfers to you. Ongoing supply replacements continue to be covered beyond that point. **What if I'm on a Medicare Advantage plan?** Coverage is similar to traditional Medicare, but each plan has its own rules for DME. Contact your plan's member services to confirm in-network suppliers and any prior authorization requirements before ordering equipment.