Sleep Apnea Devices

An overview of the devices used to treat sleep apnea: positive airway pressure (PAP) machines, oral appliances, implanted nerve stimulators, and a few smaller categories. For each one, this page summarizes who it is for, what is needed to qualify, and how Medicare and commercial insurance tend to handle coverage.

Cognia Health does not provide or dispense these devices. This overview is offered so you can have an informed conversation with your clinician about what might fit, and understand how insurers tend to treat each option.

AHI (the apnea-hypopnea index) is the average number of breathing pauses per hour of sleep; it is the measure most coverage rules use to describe sleep apnea severity.

Device Reference

Sleep Apnea Devices and Coverage

Devices are grouped by type. Filter by coverage to narrow the list. On a phone, tap More on any device for the full detail.

13 of 13 devices

PAP (positive airway pressure)

(6)

CPAP (single-level continuous)

Obstructive sleep apnea, when a sleep study shows an AHI or RDI of 15 or more (at least 30 events) or 5 to 14 with symptoms or another health condition.

Medicare covered; commercial varies Prior auth varies

Eligibility

An in-person evaluation with your clinician before the sleep test, OSA confirmed by a Medicare-recognized sleep test, and instruction from the equipment supplier.

Diagnostic requirements

OSA diagnosed by a qualifying sleep test (in-lab or home).

Who prescribes it

Your treating clinician orders it; a DME (equipment) supplier provides the device.

Medicare

Covered under Medicare policy L33718 when criteria are met.

Commercial insurance

Prior authorization varies and is required at most payers. Most plans require using the device at least 4 hours a night on 70 percent of nights, with a follow-up between day 31 and day 91.

Key limitation: Long-term use is the main challenge; roughly half of people are still using it consistently at one year.

APAP / Auto-CPAP

Obstructive sleep apnea, using the same sleep-study thresholds as CPAP, with pressure that adjusts automatically through the night.

Medicare covered; commercial varies Prior auth varies

Eligibility

Same as CPAP. Accepted as a first-line PAP option.

Diagnostic requirements

Same as CPAP: OSA diagnosed by a qualifying sleep test.

Who prescribes it

Your treating clinician orders it; a DME supplier provides the device.

Medicare

Covered under L33718, billed the same as CPAP (E0601).

Commercial insurance

Prior authorization varies; same requirements as CPAP. Aetna lists AutoPAP as an accepted option.

Key limitation: Same as CPAP.

BiPAP (bilevel without backup)

Obstructive sleep apnea when CPAP has not worked.

Medicare covered; commercial varies Prior auth varies

Eligibility

Meets CPAP criteria, plus a documented CPAP trial that proved ineffective.

Diagnostic requirements

OSA diagnosed by a qualifying sleep test, plus a documented CPAP trial that proved ineffective.

Who prescribes it

Your treating clinician orders it; a DME supplier provides the device.

Medicare

Covered under L33718 after a documented CPAP trial proves ineffective.

Commercial insurance

Prior authorization varies. Aetna and Carelon cover it when CPAP or APAP is not tolerated or is ineffective.

Key limitation: Not a first-line option for OSA.

BiPAP ST (bilevel with backup rate)

Central sleep apnea, complex sleep apnea, or hypoventilation. Not used for ordinary OSA.

Medicare covered for central apnea; commercial varies Prior auth varies

Eligibility

Central sleep apnea or hypoventilation criteria under the respiratory assist device policy.

Diagnostic requirements

An in-lab study showing central sleep apnea (AHI 5 or more, central events over 50 percent of the total, central apnea-hypopnea index 5 or more, plus a symptom) or hypoventilation/COPD criteria.

Who prescribes it

A sleep medicine or pulmonology clinician.

Medicare

Covered under the respiratory assist device policy L33800 for central sleep apnea or hypoventilation. Not covered when the main diagnosis is OSA (E0471 is denied under L33718).

Commercial insurance

Varies. Covers central sleep apnea or hypoventilation and COPD criteria.

Key limitation: Excluded when the primary diagnosis is OSA.

BiPAP ASV (adaptive servo-ventilation)

Selected central sleep apnea.

Medicare covered for central apnea; commercial varies Prior auth varies

Eligibility

Eligible central sleep apnea under the respiratory assist device policy.

Diagnostic requirements

An in-lab study confirming eligible central sleep apnea, with heart function (LVEF) over 45 percent for the ASV mode.

Who prescribes it

A sleep medicine or pulmonology clinician.

Medicare

Covered under L33800 for eligible central sleep apnea.

Commercial insurance

Varies. Carelon (Regence and Premera) covers the ASV mode only when the heart left ventricular ejection fraction is over 45 percent.

Key limitation: Contraindicated in symptomatic chronic heart failure with reduced ejection fraction (LVEF 45 percent or lower) and predominant central sleep apnea (2015 SERVE-HF).

BiPAP AVAPS

Hypoventilation or chronic respiratory failure.

Medicare covered for hypoventilation; commercial varies Prior auth varies

Eligibility

Hypoventilation or chronic respiratory failure criteria under the respiratory assist device policy.

Diagnostic requirements

Documentation of hypoventilation or COPD-related chronic respiratory failure.

Who prescribes it

A sleep medicine or pulmonology clinician.

Medicare

Covered under L33800 for hypoventilation or chronic respiratory failure.

Commercial insurance

Varies. Covers hypoventilation or COPD-related chronic respiratory failure.

Key limitation: Not for uncomplicated OSA.

Oral appliances

(3)

Custom oral appliance (MAD)

Obstructive sleep apnea: severe (AHI over 30) or mild to moderate (AHI 15 to 30, or 5 to 14 with symptoms).

Medicare covered; commercial varies Prior auth varies

Eligibility

A custom, adjustable mandibular advancement device with a fixed hinge; a face-to-face evaluation before the sleep test; no active gum disease (commercial plans).

Diagnostic requirements

A qualifying sleep test, plus a face-to-face evaluation before the test.

Who prescribes it

A sleep or medical clinician orders it; a licensed dentist (DDS or DMD) fabricates and bills it.

Medicare

Covered under L33611 when provided and billed by a licensed dentist (DDS or DMD).

Commercial insurance

Prior authorization varies. Commercial plans (Carelon) generally require that PAP is not a candidate, is ineffective, or was not tolerated after a 45-day trial. Must be billed by a dentist.

Key limitation: Less effective in severe OSA; possible dental side effects.

Prefabricated oral appliance

Obstructive sleep apnea (ready-made, not custom).

Not typically covered

Eligibility

Not a covered route under Medicare.

Diagnostic requirements

Not applicable; Medicare considers prefabricated appliances not reasonable and necessary.

Who prescribes it

A dentist.

Medicare

Not covered by Medicare (L33611 denies prefabricated appliances for insufficient evidence).

Commercial insurance

Typically not covered.

Key limitation: Non-covered.

Tongue retaining/stabilizing device (TSD/TRD)

Obstructive sleep apnea or snoring.

Not typically covered

Eligibility

Limited; not a covered route.

Diagnostic requirements

Not applicable; bills as a non-covered item.

Who prescribes it

A dentist.

Medicare

Not separately covered; bills as A9270 (non-covered) per the L33611 Policy Article A52512.

Commercial insurance

Typically not covered.

Key limitation: Generally not reimbursed.

Nerve stimulation (implanted)

(2)

Hypoglossal nerve stimulation - Inspire

Moderate to severe obstructive sleep apnea, AHI 15 to 65 (Medicare) or 15 to 100 (commercial UHC), after CPAP failure or intolerance.

Medicare covered; commercial varies Prior auth required

Eligibility

Age 22 or older; BMI under 35 (Medicare) or up to 40 (commercial UHC); central and mixed events under 25 percent; no complete concentric collapse on DISE; CPAP failure or intolerance.

Diagnostic requirements

A sleep study (PSG) within 24 months and a drug-induced sleep endoscopy (DISE) confirming no complete concentric collapse.

Who prescribes it

An ENT or sleep surgeon.

Also approved for

Also FDA-approved (2023) for adolescents 13 to 18 with Down syndrome and severe OSA (AHI 10 to 50) who cannot benefit from CPAP.

Medicare

Covered under L38528 for moderate to severe OSA when criteria are met.

Commercial insurance

Prior authorization required. Requires a sleep study within 24 months, predominantly obstructive events, a DISE, and documented CPAP failure or intolerance with shared decision-making.

Key limitation: Invasive, with narrow eligibility (excludes complete concentric collapse, high BMI, and very high AHI).

Hypoglossal nerve stimulation - Genio (Nyxoah)

Moderate to severe obstructive sleep apnea.

Medicare covered; commercial varies Prior auth required

Eligibility

Per FDA labeling, effectiveness is not established outside certain limits: age under 22 or over 75, BMI over 32, AHI under 15 or over 65, or complete concentric collapse. These are FDA labeling limits, not insurance coverage cutoffs.

Diagnostic requirements

The same hypoglossal nerve stimulation workup as Inspire (sleep study plus DISE).

Who prescribes it

An ENT or sleep surgeon.

Medicare

Covered under L38528 as an FDA-approved hypoglossal nerve stimulation device.

Commercial insurance

Prior authorization required; the same hypoglossal nerve stimulation pathway as Inspire.

Key limitation: Newer; bilateral stimulation; eligibility limits.

Other devices

(2)

Positional therapy (NightBalance / Somnibel)

Positional (supine-predominant) obstructive sleep apnea.

Not typically covered (often cash-pay)

Eligibility

Supine-predominant (positional) OSA.

Diagnostic requirements

A sleep study showing supine-predominant (positional) OSA.

Who prescribes it

A sleep clinician.

Medicare

No specific Medicare coverage path.

Commercial insurance

Typically not covered; often cash-pay. NightBalance was discontinued by Philips in 09-2023 (existing-device support stated through 05-2027).

Key limitation: Often cash-pay; limited availability.

Daytime tongue stimulation (eXciteOSA)

Snoring and mild OSA (AHI under 15), ages 18 and older.

Not typically covered (cash-pay)

Eligibility

Mild OSA or primary snoring, ages 18 and older.

Diagnostic requirements

For snoring or mild OSA (AHI under 15).

Who prescribes it

By prescription (physician or dentist).

Medicare

No specific Medicare coverage path.

Commercial insurance

Not typically covered; cash-pay. Used 20 minutes a day for 6 weeks, then twice a week.

Key limitation: Mild OSA only; generally not reimbursed.

From the practice

These guides are educational. Care at Cognia Health draws on training in both psychology and psychiatry, with longer appointments and individualized planning. Read about my approach to care or explore services .