Medicare does cover BiPAP machines when a doctor prescribes one for a qualifying respiratory condition and the clinical documentation meets Medicare’s rules. Coverage sits under Part B as durable medical equipment. After you meet the annual Part B deductible of $283 in 2026, you pay 20% of the Medicare-approved amount and Medicare pays 80%.1Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles Payment runs as a 13-month rental, and the machine becomes yours at the end of that period.2eCFR. 42 CFR 414.229 – Capped Rental Items
The catch is that Medicare treats a BiPAP as a step up from a CPAP, not a substitute for one. Which diagnosis you have, what your sleep study shows, and whether you actually use the machine in the first three months all decide whether coverage sticks.
Diagnoses That Qualify for a BiPAP
A BiPAP delivers two pressure levels, one for inhaling and one for exhaling, and Medicare wants to see a clinical reason that a simpler CPAP won’t do the job.
Obstructive Sleep Apnea Requires a Documented CPAP Failure
For obstructive sleep apnea, Medicare’s default covered device is a CPAP. To move you to a BiPAP (billing code E0470), your treating provider has to document that you tried a CPAP first and it failed. The record needs to show the mask fit properly and you were able to use it, but the pressure settings couldn’t adequately control your symptoms, didn’t improve sleep quality, or didn’t bring your apnea events down to acceptable levels.3Centers for Medicare & Medicaid Services. Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea Without that documented failure, Medicare will deny a BiPAP for OSA.
Central and Complex Sleep Apnea
Central sleep apnea and complex sleep apnea fall under a different policy. These involve the brain failing to signal breathing rather than a blocked airway. A BiPAP with a backup breathing rate (code E0471) is covered under Medicare’s Respiratory Assist Devices criteria. Complex sleep apnea is diagnosed when central apnea events persist or emerge after a CPAP has effectively treated the obstructive events.4CGS Medicare. Respiratory Assist Devices for Central Sleep Apnea or Complex Sleep Apnea
Severe COPD and Hypoventilation Syndromes
Medicare also covers BiPAP devices for severe COPD and hypoventilation syndromes under separate criteria. Here the sleep study has to show oxygen saturation dropping to 88% or below for at least five cumulative minutes during a recording of at least two hours, and those drops can’t be caused by obstructive airway events.5Centers for Medicare & Medicaid Services. Respiratory Assist Devices
You Need a Sleep Study First
Before Medicare will authorize a BiPAP, your doctor has to conduct a clinical evaluation and then order a sleep study. That means either a facility-based polysomnogram in a sleep lab or a home sleep test, depending on what your doctor suspects.6Medicare. Sleep Studies Medicare covers Type I polysomnograms only when performed in a sleep lab facility. The results have to meet the diagnostic thresholds tied to your condition, whether that’s an apnea-hypopnea index score for OSA or the oxygen desaturation numbers for hypoventilation.
The 90-Day Compliance Rule
This is where most BiPAP claims fall apart. Medicare doesn’t just approve the device and move on. During the first three months, you have to prove you’re actually using it.
The standard: at least four hours per night on 70% of nights during any consecutive 30-day stretch within the first three months. Your DME supplier tracks this through the machine’s data card or wireless modem. Between day 31 and day 91, your treating provider has to see you face-to-face, review the adherence data, and document how treatment is going.7Centers for Medicare & Medicaid Services. Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
Miss the usage threshold or skip the follow-up visit, and Medicare will deny continued coverage of the device and its accessories as not reasonable and necessary. You would then owe the full cost or need to return the equipment.
What You’ll Pay
Under Original Medicare, your out-of-pocket costs come in two pieces. First, the annual Part B deductible of $283 in 2026.1Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles After that, you pay 20% coinsurance on the Medicare-approved amount for each monthly rental payment and for supplies. Medicare pays the remaining 80%.
A Medigap supplemental policy can reduce or eliminate the 20% coinsurance, depending on which plan you carry. If you’re on a Medicare Advantage plan instead of Original Medicare, your rules and costs differ. Advantage plans have to cover everything Original Medicare covers but can set their own cost sharing and network rules.8Centers for Medicare & Medicaid Services. Original Medicare vs. Medicare Advantage Some charge a flat copay for DME rather than the 20% coinsurance, which can work out better or worse depending on the approved amount.
Choose your DME supplier carefully. Suppliers who don’t accept Medicare assignment can charge you significantly more. Ask before you take the equipment, and get the answer in writing.
Renting for 13 Months, Then You Own It
Medicare pays for a BiPAP through a capped rental. You rent the device month by month for up to 13 consecutive months. After the 13th rental payment, the supplier has to transfer ownership to you at no additional charge.2eCFR. 42 CFR 414.229 – Capped Rental Items Monthly rental charges stop at that point, but Medicare keeps covering supplies and medically necessary repairs.
Supplies Medicare Covers
Replacement supplies are covered on a fixed schedule. Order more often than Medicare allows and the extras are on you. Standard replacement frequencies:
- Nasal mask cushions or pillows: every two weeks
- Full-face mask cushion: every month
- Mask frame: every three months
- Tubing: every three months
- Disposable filters: every two weeks
- Non-disposable filters: every six months
- Humidifier water chamber: every six months
The same 20% coinsurance applies to supplies after the deductible is met. Watch automatic shipment programs closely. Suppliers sometimes send items before you’re eligible, and if Medicare denies the claim, you’re the one on the hook.
Repairs and Replacement After You Own the Machine
Once you own the BiPAP, Medicare still covers medically necessary repairs. It pays 80% of the approved amount for parts and labor and you pay 20%.9Medicare. Medicare Coverage of Durable Medical Equipment and Other Devices The supplier that rented you the machine isn’t required to repair it after ownership transfers, so you may need to find a different Medicare-enrolled supplier for the work.
For a full replacement, Medicare generally won’t pay for a new machine until the current one has reached its reasonable useful lifetime, set at a minimum of five years from the original delivery date. Exceptions apply if the device is lost, stolen, or irreparably damaged before that mark, with documentation. After five years, you can start the process over with a new prescription and a new 13-month rental.