Key takeaways
- E0601 is the HCPCS code for a continuous positive airway pressure (CPAP) device. Medicare pays for it as a rental.
- Coverage rests on a face-to-face evaluation, a qualifying sleep test and, after the first months, documented use of the device.
- Masks, tubing, filters and other supplies have their own codes and replacement limits.
- Most CPAP denials come from missing sleep test results, no adherence record, or the wrong rental modifier.
What E0601 covers
E0601 is the code for a CPAP device used to treat obstructive sleep apnea. A heated humidifier is billed separately (for example E0562), and the mask, tubing, filters and headgear are supplies with their own A codes. Medicare generally pays for the device as a capped rental, so billing continues month by month.
Coverage criteria are set in the contractors’ policy for positive airway pressure devices. The summary below is general. Check the current policy before you bill.
The documentation a CPAP claim needs
| Stage | What must be on file |
|---|---|
| Before testing | A face-to-face clinical evaluation by the treating practitioner |
| Sleep test | Results of a qualifying sleep test that meet the policy’s criteria for the diagnosis |
| Order | A valid written order from the treating practitioner |
| Delivery | Proof of delivery with the date and patient signature |
| First months | Device data or records that show the patient is using the CPAP as the policy requires |
| Follow-up | A later clinical re-evaluation documenting that the therapy is helping |
The adherence check
For continued Medicare coverage, a patient generally has to show regular use of the device in the first few months, and the practitioner has to document benefit. The policy sets the exact hours, nights and time window. If the record does not show it, payment can stop after the first months, and the supplier may be asked to refund what was paid. Build a process that collects device data and the follow-up note before the date you need them.
Rental billing and KX
Because E0601 is a capped rental, each month is billed with a rental modifier. After the first months, the KX modifier is generally needed to show that the policy requirements, including adherence, have been met. Use it only when the records prove it. See our DME modifiers guide and KX modifier guide.
CPAP supply codes and resupply
| Code | Item |
|---|---|
| A7030 | Full face mask |
| A7031 | Full face mask cushion |
| A7034 | Nasal interface (mask or cannula) |
| A7035 | Headgear |
| A7037 | Tubing |
| A7038 · A7039 | Disposable and non-disposable filters |
Each supply has a limit on how often it is covered, usually set per three or six months or per month. Confirm the current limits in the policy and bill resupply only when the patient is eligible and has confirmed the need.
Common CPAP billing mistakes
- No qualifying sleep test result in the file.
- No adherence data when the review date arrives.
- Billing later rental months without KX when it is required, or with KX when the records do not support it.
- Skipped rental months.
- Resupply billed too often, or without patient confirmation.
Our DME billing services track these dates for you.
CPAP billing FAQ
What is the E0601 code?
E0601 is the HCPCS code for a continuous positive airway pressure (CPAP) device used to treat obstructive sleep apnea.
Does Medicare pay for a CPAP as a rental or a purchase?
Medicare generally pays for CPAP devices as capped rentals, billed month by month. Check the current policy for the exact rules.
What is the CPAP adherence requirement?
A patient generally has to show regular use of the device in the first months, and the practitioner has to document that the therapy is helping. The policy sets the exact numbers.
Which modifier goes on CPAP rental claims?
Rental claims carry the rental modifier and the month group modifier, and KX is generally required after the first months when requirements are met.
How often can CPAP supplies be billed?
Each supply code has its own limit, usually set per month, three months or six months. Confirm the current limits in the policy.