How many hours a night do I need to use CPAP for insurance?

Medicare's standard is at least 4 hours per night on 70% of nights (21 of 30) during a consecutive 30-day period in the first three months. Many private plans use the same or similar rules.

Can I appeal if I missed the compliance target by a little?

You can, but plans usually apply the numbers strictly. A doctor's note explaining a specific reason, such as a mask problem that has since been fixed, plus a request for a new trial is often more effective.

Does insurance cover CPAP supplies?

Usually yes, on a replacement schedule set by the plan (for example, cushions monthly and masks every few months). Replacing them sooner normally needs a documented reason.

What if I bought my CPAP before getting new insurance?

Your new plan may still cover supplies and repairs, but it will usually want its own proof of diagnosis and ongoing benefit. Call before ordering.

CPAP Insurance Denial: Compliance Rules and How to Appeal

By AppealFlow editorial•5 min read•Published October 2026

Most CPAP denials come from compliance rules: Medicare and many private plans keep paying for the machine only if data shows you used it at least 4 hours a night on 70% of nights in a 30-day stretch during the first 90 days, plus a follow-up visit confirming it helps. If your device data is missing or you fell short, you can often fix it by downloading the usage report, seeing your doctor, and requesting a new trial or appeal rather than paying full price.

Why Was My CPAP Denied?

Key Takeaway: Pin down which rule the denial letter cites; the fix is different for each.

No qualifying sleep study: the plan didn't receive a home or in-lab sleep test meeting its criteria (often an apnea-hypopnea index of 15 or more, or 5 to 14 with symptoms or conditions such as hypertension). See how to appeal a denied sleep study.
Compliance not met: usage data showed fewer than 4 hours a night on 70% of nights during a consecutive 30-day period.
No follow-up visit: Medicare requires an in-person or telehealth re-evaluation between day 31 and day 91 documenting that symptoms improved and you're using the device.
Supplies: masks, cushions and filters denied for being replaced sooner than the plan's schedule.
Prior authorization or network: the supplier wasn't in-network or didn't get approval.

What Are the Medicare CPAP Compliance Rules?

Key Takeaway: Private plans often copy these, so they're a useful baseline.

Medicare covers CPAP for an initial 12-week trial. Continued coverage requires both objective adherence (at least 4 hours per night on 70% of nights during a consecutive 30-day period within the first three months) and a clinical re-evaluation between the 31st and 91st day. If you fail the trial, Medicare generally requires a new face-to-face evaluation and often a repeat sleep test in a facility before a new trial. Commercial plans set their own rules, so read your plan's durable medical equipment policy.

How Do I Appeal a CPAP Denial?

Key Takeaway: Data wins these appeals.

Ask your supplier or sleep doctor for the device's compliance download covering your best 30 consecutive days. Many machines store this even if the modem failed.
If you hit the target but the report never reached the plan, send it with your appeal; this is the most common easy win.
If you fell short because of a mask fit problem, illness, travel or a power outage, ask your doctor to document it and request a new trial.
Make sure your follow-up visit note states that you're using the CPAP and that symptoms such as daytime sleepiness have improved.
File the appeal by the deadline on your notice. Medicare Part B redeterminations must generally be requested within 120 days of the notice; commercial plans often allow 180 days.

How Can I Keep Coverage Going?

Key Takeaway: A few habits protect you from a mid-rental denial.

Most plans rent the machine for several months before you own it, and each rental period can be reviewed. Wear the mask for most of the night, check your app or the device's report each week, and contact your supplier early if the mask leaks or is uncomfortable; changing the mask style is routine. If you're switching plans, ask the new plan what it needs, since your old compliance record may not transfer automatically.

Related Guides

Frequently Asked Questions

Sources

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Disclaimer: This article is for educational purposes only and does not constitute medical, legal, or financial advice. Plan terms, state laws, and federal rules vary and change. Check your plan documents and denial notice, and consider a licensed professional or your state consumer assistance program. See our full disclaimer.