CPAP and Resupply Billing Services
CPAP billing for DME suppliers, from the first order through years of resupply, without the documentation gaps that turn paid claims into recoupments.
- Intake and qualifying documentation review
- 90-day compliance tracking
- Capped rental month billing
- Resupply frequency and contact checks
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HIPAA compliant. We never share your data.
Why suppliers hand us their CPAP billing
- 99.9% accuracy on the claims we work
- 97% collection rate
- We work inside Brightree, Bonafide, NikoHealth or TIMS
- HIPAA compliant handling of patient data
- ISO 9001 and ISO 27001 certified
- Each payer’s PAP rules kept in your billing setup
Getting the first claim right
Most CPAP denials start before the device ships. Medicare requires a clinical evaluation by the treating practitioner before the sleep test, then a qualifying test, either in a sleep lab or at home. An AHI or RDI of 15 or more qualifies on its own. A result of 5 to 14 qualifies only with documented symptoms or conditions such as excessive daytime sleepiness, impaired cognition, mood disorders, insomnia, hypertension, ischemic heart disease or a history of stroke.
Our intake team checks the dates, the test and the order before anything moves forward. If your practice also runs diagnostic studies, our sleep lab billing team can keep the testing side and the equipment side in step.
The 90-day compliance window, explained
Coverage after the first three months depends on two things. First, the device data has to show use of 4 or more hours per night on at least 70% of nights during 30 consecutive days, at any point in the first three months. Second, between day 31 and day 91 of therapy, the treating practitioner has to re-evaluate the patient in person, document that sleep apnea symptoms have improved, and review the usage data.
When both are documented, claims continue with the KX modifier. If the re-evaluation happens after day 91 but still shows benefit, coverage resumes from the date of that visit.
A patient who fails the trial generally needs a new in-person evaluation and a repeat sleep test in a facility before starting a new trial.
We don’t wait for day 90 to find out where a patient stands. We flag patients whose usage is slipping while there is still time to help, so your staff can step in with a mask refit or coaching, and the re-evaluation visit gets scheduled instead of discovered missing at audit.
Billing systems we work in
We log in to the system you already use. No migration, no new software for your team.
How we run your CPAP billing
Every step below happens inside your billing system, so your team can see where each patient and claim stands.
Before the claim
- Intake review: we check the evaluation, sleep test and order before the device is delivered.
- Compliance tracking: we watch usage data and the re-evaluation date while the 90-day window is open.
- Rental month setup: Medicare pays CPAP (E0601) and bilevel without a backup rate (E0470) as capped rental items, billed monthly for up to 13 months, after which the patient owns the device. We set each month with the right modifiers for where the patient is in the compliance process, and watch for breaks in service or a wrong month count.
After the claim
- Resupply checks: every refill is matched to frequency limits, contact dates and same-or-similar history before billing.
- Payer rules: many PAP patients are on commercial or Medicare Advantage plans with their own frequencies and authorization rules. We keep each plan’s rules separate so one schedule never gets applied to another.
- Denial follow-up: we work denials by root cause and feed what we learn back into intake.
Resupply that holds up in an audit
Medicare sets a usual maximum for each PAP supply:
| Supply | HCPCS | Usual maximum |
|---|---|---|
| Full face mask | A7030 | 1 every 3 months |
| Full face cushion | A7031 | 1 per month |
| Nasal cushion | A7032 | 2 per month |
| Nasal pillows | A7033 | 2 per month |
| Nasal mask | A7034 | 1 every 3 months |
| Headgear | A7035 | 1 every 6 months |
| Tubing | A7037 | 1 every 3 months |
| Disposable filter | A7038 | 2 per month |
| Nondisposable filter | A7039 | 1 every 6 months |
| Humidifier water chamber | A7046 | 1 every 6 months |
Timing matters as much as quantity. Before each refill, the supplier has to contact the patient no sooner than 30 days before the current supply runs out, and deliver no sooner than 10 days before. We document each contact and line up dates of service with the schedule.
Read how we tightened recurring rental billing and documentation for a DME supplier.
What keeps your CPAP claims clean
Certified processes
ISO 9001 quality management and ISO 27001 information security, audited by outside bodies.
Caught before billing
Documentation, compliance and frequency checks happen before a claim goes out, not after a denial.
Lessons fed back
Every denial we work gets traced to its cause and fixed at intake.
Your patient data stays protected
We handle patient records under HIPAA and an ISO 27001 certified information security program. We work in your own billing system, so your data stays where it already lives.
When a CPAP claim is denied
A denied rental month or resupply claim usually points to something upstream: a late re-evaluation, a missing contact record, a same-or-similar conflict. We work the denial, and we fix the step that caused it so it doesn’t repeat next month.
What changes when we take over
- Fewer surprises at audit. Compliance, re-evaluation and refill records are in place before anyone asks.
- No new software. We work in Brightree, Bonafide, NikoHealth or TIMS.
- One team for the whole program. From first order to ongoing resupply, plus the rest of your DME billing services.
Fewer denials start with better front-end checks. See our DME denial reduction case study.
Related Reading
Guides and results for DME suppliers
DME Capped Rental Billing: How to Track the 13 Months
Avoid lost rental payments with a clean month-by-month tracking process.
Read more →GuideHow to Choose a DME Billing Partner
What to check beyond price before you hand over your claims.
Read more →Case StudiesDME Billing Case Studies
See how we’ve fixed denials, delays and underpayments for DME suppliers.
Read more →Frequently asked questions
What does Medicare count as CPAP compliance?
Use of 4 or more hours per night on at least 70% of nights during 30 consecutive days, within the first three months of therapy. It has to come from the device data, and the treating practitioner has to review it.
When does the re-evaluation visit have to happen?
Between day 31 and day 91 after therapy starts. The practitioner sees the patient in person and documents that symptoms have improved.
How long does Medicare rent a CPAP before the patient owns it?
CPAP is a capped rental item, paid monthly for up to 13 months. After that, the patient owns the device.
How early can we contact a patient about a refill?
No sooner than 30 days before the current supply runs out, and the delivery can go out no sooner than 10 days before.