How to Replace a CPAP Under Medicare: Rules by Situation

Updated November 2026. Written by Matteo Grassi, clinical psychologist and cofounder of HANA Health.

Medicare sets a reasonable useful lifetime of five years for a CPAP device, counted from the delivery date. Under LCD L33718, revised January 2024, a lost, stolen or irreparably damaged device can be replaced inside that window with no new sleep test or trial. After five years, the treating practitioner must document in person that the patient still uses and benefits from therapy.

Key facts

• The reasonable useful lifetime (RUL) of a PAP device is 5 years, and the count runs from delivery to the patient (LCD L33718; 42 CFR 414.210).
• Replacement inside the RUL after loss, theft or irreparable damage from a specific incident needs no new clinical evaluation, sleep test or trial period (CMS MLN).
• Replacement after the RUL needs an in person evaluation showing continued use and benefit, with no new sleep test or trial (CMS MLN).
• A patient who started PAP before joining fee for service Medicare needs a qualifying sleep test from before enrollment plus an in person evaluation after enrollment (LCD L33718).
• A patient who fails the first 12 week trial must have an in person re-evaluation and a repeat facility based sleep test to requalify (LCD L33718).
• CMS reported a 12.5% improper payment rate for CPAP in 2024, a projected $146.1 million, and 71.2% of the PAP errors were insufficient documentation (CMS MLN).

How long does a Medicare CPAP last before it can be replaced?

Five years. Medicare calls this the reasonable useful lifetime, or RUL, and the clock starts when the device is delivered to the patient. It doesn't start when the machine was built, and it doesn't restart when the patient takes ownership after the rental period.

The regulation sets the floor. Under 42 CFR 414.210, the RUL of durable medical equipment can't be shorter than five years, and the computation is based on the delivery date. LCD L33718 then names a 5 year RUL for PAP devices.

Here's what that looks like in practice. A CPAP delivered on 3 November 2022 reaches the end of its RUL on 3 November 2027. A device delivered in March 2021 passed that point in March 2026.

A patient who has used the same device continuously for the whole RUL may elect to get a new one. Replacement before the RUL ends is possible only in narrow situations, covered next.

One scope note: the LCD's replacement section applies to PAP devices first provided and covered while the patient was in fee for service Medicare. Patients who started therapy before joining Medicare follow a separate path, covered further down.

What if the CPAP is lost, stolen or damaged before five years?

If a PAP device is replaced during the RUL because of loss, theft or irreparable damage due to a specific incident, Medicare doesn't require a new clinical evaluation, a new sleep test or a new trial period. The patient doesn't start over.

The LCD wording is "due to a specific incident," so your notes matter. Record what happened and when: a fire, a flood, a theft, a crushed device. A machine that simply wears out is a different conversation, and your DME MAC publishes a clinician letter on PAP replacements that shows what it wants to see.

A worked example with the dates shown line by line:

• Delivery date: 3 November 2022.
• RUL ends: 3 November 2027 (five years from delivery).
• Event: device stolen in February 2027, which falls inside the RUL.
• Result: replacement without a new evaluation, sleep test or trial, if the incident is documented.

What does Medicare require to replace a CPAP after five years?

Once the RUL has passed, the rule changes in one way. The treating practitioner must conduct an in person evaluation and document that the patient continues to use and benefit from the PAP device. There's still no requirement for a new sleep test or a new trial period.

Here's the checklist most suppliers work from:

1. Confirm the original delivery date and that five years have passed.
2. Get the patient in front of the treating practitioner for an in person evaluation.
3. Make sure the note says the patient continues to use the device and benefits from it.
4. File that note in the record and match the rest of your paperwork to your DME MAC's PAP checklist.

Proof of continued use doesn't have to be a data download. Noridian's PAP guidance says suppliers needn't keep documenting adherence after the first three months, and that beneficiary attestation can document continued use.

The 4 hours a night on 70% of nights test isn't on that list. It belongs to the first trial, which our guide to Medicare CPAP compliance requirements explains. A replacement after five years asks a simpler question: is the patient still using this therapy, and does it help?

What about patients who started CPAP before they joined Medicare?

Patients who got a PAP device before enrolling in fee for service Medicare can still get coverage for rental, a replacement device or accessories, but both of these requirements must be met:

1. Sleep test: documentation of a sleep test, done before FFS enrollment, that meets the Medicare AHI or RDI coverage criteria in effect when the patient seeks coverage.
2. Clinical evaluation: after enrolling in FFS Medicare, an in person evaluation by the treating practitioner documenting that the patient has a diagnosis of obstructive sleep apnea and continues to use the PAP device.

If either piece is missing, CMS denies the claim as not reasonable and necessary. In these situations there's no requirement for a clinical re-evaluation or objective adherence documentation, so the 90 day trial test doesn't apply.

Noridian adds a practical point: a new standard written order is required before you can begin billing Medicare fee for service. It also says that if a device was billed to fee for service and the patient moved to a Medicare HMO, billing resumes where it left off on return, with documentation of continued use and need.

Ask for the old sleep report at intake. It's the item most likely to be missing.

When does a patient have to start over with a new sleep test?

A patient starts over when the first 12 week trial fails. Patients who fail the initial trial can re-qualify for a PAP device, but they need both of these:

1. An in person clinical re-evaluation by the treating practitioner to determine why the patient didn't respond to PAP therapy.
2. A repeat sleep test in a facility based setting (a Type 1 study). It can be a repeat diagnostic, a titration or a split night study.

Close doesn't count. Noridian's PAP guidance says continued coverage can't be extended to patients who come near the adherence standard but don't meet all of it in the 90 day window.

Replacement leaves the original qualification intact. A failed trial means the qualification never completed. For the first trial and its day 31 to 91 visit, see our guide to the CPAP face to face reevaluation. For how rental months and ownership fit together, see how the 13 month capped rental works.

What happens to masks and supplies when the patient owns the machine?

If Medicare paid for the base device through 13 months of continuous use, Medicare assumes the medical need for that beneficiary owned machine was established. To pay for replacement accessories such as interfaces, tubing, filters and humidifier chambers, the policy article asks for two things:

• Continued need for the base item: documentation from the treating practitioner's records that the base device still meets the patient's medical need.
• Need for the accessory: supplier records showing the replacement is needed to keep the equipment working and meet the patient's medical need.

That shortcut doesn't apply when Medicare never paid for the base device. In that case, every coverage, coding and documentation requirement in effect on the date of service must be met.

Noridian also lists what supply claims for beneficiary owned equipment must carry, and a claim missing any one of the three is denied for missing information: the HCPCS code of the base equipment, a notation that the equipment is beneficiary owned, and the approximate date the beneficiary obtained it.

For the supply schedule itself, see our guide to the Medicare CPAP resupply schedule.

What this means for your DME

Replacement problems usually start with a record that can't say which rule applies to this patient. A few habits fix that.

• Flag the RUL date at delivery. Add five years to the delivery date and put it in the patient record so the after five years rule is visible before the call comes in.
• Ask about prior therapy at intake. Note when the patient joined fee for service Medicare, who supplied the first device, and whether a sleep report exists.
• Capture the incident. For a loss or theft inside the RUL, write down the date and what happened.
• Keep the evaluation note findable. The after five years rule lives or dies on one line: continues to use and benefit.

The stakes are real: CMS puts the 2024 improper payment rate for CPAP at 12.5%, and 71.2% of PAP improper payments were insufficient documentation.

HANA works with DME teams on adherence and resupply outreach by phone, and the sleep page describes what that covers. These rules apply to Original Medicare. Medicare Advantage and commercial payers can differ, as our piece on commercial payer CPAP adherence rules shows.

Frequently asked questions

Does Medicare pay for a new CPAP if the old one still works after five years?

The regulation says a patient who has used equipment continuously for its reasonable useful lifetime may elect to obtain a new one. For PAP devices, the LCD then asks for an in person evaluation documenting continued use and benefit. Your DME MAC decides how it wants that documented.

Can a nurse practitioner or physician assistant do the in person evaluation?

Noridian's PAP page says nurse practitioners, clinical nurse specialists and physician assistants may conduct initial and follow up evaluations. For a replacement evaluation, check your DME MAC's clinician letter on PAP replacements before you rely on it.

Do I need a new written order for a replacement device?

Noridian says a new standard written order is required to begin billing Medicare fee for service for a patient who was already on PAP before enrolling. For other replacements, use your DME MAC's replacement letter and checklist, because order details can vary by situation.

What if repairs on a patient owned machine keep adding up?

When a supplier transferred title under the capped rental rules and the item won't last the full RUL, the regulation makes the supplier responsible for a replacement at no cost to the patient or Medicare. The carrier may weigh whether accumulated repair costs exceed 60 percent of the replacement cost.

Does a replacement start a new 12 week trial?

Not in the situations covered here. Replacement after a specific incident, or after the RUL has passed, carries no new trial requirement. A failed first trial is what sends a patient back through qualification.

Sources

1. Centers for Medicare and Medicaid Services, Local Coverage Determination L33718, Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea, revision effective 1 January 2024, including the related policy article.
2. Electronic Code of Federal Regulations, 42 CFR 414.210, General payment rules for durable medical equipment, current edition.
3. Centers for Medicare and Medicaid Services, Continuous Positive Airway Pressure Devices and Accessories, Medicare Learning Network provider compliance tips, updated for the 2024 reporting period.
4. Noridian Healthcare Solutions, Positive Airway Pressure (PAP) Devices, JD DME, current page.

This article is educational and isn't billing, coding, clinical or legal advice. Check current CMS guidance and your MAC before you bill. If you want to talk through how your team handles CPAP outreach and documentation, book a call with Matteo.