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.
Sleep Apnea Devices and Coverage
Devices are grouped by type. Filter by coverage to narrow the list. On a phone, tap the arrow on any device for the full detail.
13 of 13 devices
PAP (positive airway pressure)
(6)No devices in this category match the current filters.
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.
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.
OSA diagnosed by a qualifying sleep test (in-lab or home).
Your treating clinician orders it; a DME (equipment) supplier provides the device.
Covered under Medicare policy L33718 when criteria are met.
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.
APAP / Auto-CPAP
Obstructive sleep apnea, using the same sleep-study thresholds as CPAP, with pressure that adjusts automatically through the night.
Same as CPAP. Accepted as a first-line PAP option.
Same as CPAP: OSA diagnosed by a qualifying sleep test.
Your treating clinician orders it; a DME supplier provides the device.
Covered under L33718, billed the same as CPAP (E0601).
Prior authorization varies; same requirements as CPAP. Aetna lists AutoPAP as an accepted option.
BiPAP (bilevel without backup)
Obstructive sleep apnea when CPAP has not worked.
Meets CPAP criteria, plus a documented CPAP trial that proved ineffective.
OSA diagnosed by a qualifying sleep test, plus a documented CPAP trial that proved ineffective.
Your treating clinician orders it; a DME supplier provides the device.
Covered under L33718 after a documented CPAP trial proves ineffective.
Prior authorization varies. Aetna and Carelon cover it when CPAP or APAP is not tolerated or is ineffective.
BiPAP ST (bilevel with backup rate)
Central sleep apnea, complex sleep apnea, or hypoventilation. Not used for ordinary OSA.
Central sleep apnea or hypoventilation criteria under the respiratory assist device policy.
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.
A sleep medicine or pulmonology clinician.
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).
Varies. Covers central sleep apnea or hypoventilation and COPD criteria.
BiPAP ASV (adaptive servo-ventilation)
Selected central sleep apnea.
Eligible central sleep apnea under the respiratory assist device policy.
An in-lab study confirming eligible central sleep apnea, with heart function (LVEF) over 45 percent for the ASV mode.
A sleep medicine or pulmonology clinician.
Covered under L33800 for eligible central sleep apnea.
Varies. Carelon (Regence and Premera) covers the ASV mode only when the heart left ventricular ejection fraction is over 45 percent.
BiPAP AVAPS
Hypoventilation or chronic respiratory failure.
Hypoventilation or chronic respiratory failure criteria under the respiratory assist device policy.
Documentation of hypoventilation or COPD-related chronic respiratory failure.
A sleep medicine or pulmonology clinician.
Covered under L33800 for hypoventilation or chronic respiratory failure.
Varies. Covers hypoventilation or COPD-related chronic respiratory failure.
Oral appliances
(3)No devices in this category match the current filters.
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).
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).
A qualifying sleep test, plus a face-to-face evaluation before the test.
A sleep or medical clinician orders it; a licensed dentist (DDS or DMD) fabricates and bills it.
Covered under L33611 when provided and billed by a licensed dentist (DDS or DMD).
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.
Prefabricated oral appliance
Obstructive sleep apnea (ready-made, not custom).
Not a covered route under Medicare.
Not applicable; Medicare considers prefabricated appliances not reasonable and necessary.
A dentist.
Not covered by Medicare (L33611 denies prefabricated appliances for insufficient evidence).
Typically not covered.
Tongue retaining/stabilizing device (TSD/TRD)
Obstructive sleep apnea or snoring.
Limited; not a covered route.
Not applicable; bills as a non-covered item.
A dentist.
Not separately covered; bills as A9270 (non-covered) per the L33611 Policy Article A52512.
Typically not covered.
Nerve stimulation (implanted)
(2)No devices in this category match the current filters.
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.
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.
A sleep study (PSG) within 24 months and a drug-induced sleep endoscopy (DISE) confirming no complete concentric collapse.
An ENT or sleep surgeon.
Also FDA-approved (2023) for adolescents 13 to 18 with Down syndrome and severe OSA (AHI 10 to 50) who cannot benefit from CPAP.
Covered under L38528 for moderate to severe OSA when criteria are met.
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.
Hypoglossal nerve stimulation - Genio (Nyxoah)
Moderate to severe obstructive sleep apnea.
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.
The same hypoglossal nerve stimulation workup as Inspire (sleep study plus DISE).
An ENT or sleep surgeon.
Covered under L38528 as an FDA-approved hypoglossal nerve stimulation device.
Prior authorization required; the same hypoglossal nerve stimulation pathway as Inspire.
Other devices
(2)No devices in this category match the current filters.
Positional therapy (NightBalance / Somnibel)
Positional (supine-predominant) obstructive sleep apnea.
Supine-predominant (positional) OSA.
A sleep study showing supine-predominant (positional) OSA.
A sleep clinician.
No specific Medicare coverage path.
Typically not covered; often cash-pay. NightBalance was discontinued by Philips in 09-2023 (existing-device support stated through 05-2027).
Daytime tongue stimulation (eXciteOSA)
Snoring and mild OSA (AHI under 15), ages 18 and older.
Mild OSA or primary snoring, ages 18 and older.
For snoring or mild OSA (AHI under 15).
By prescription (physician or dentist).
No specific Medicare coverage path.
Not typically covered; cash-pay. Used 20 minutes a day for 6 weeks, then twice a week.
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 .