The rule in plain words
- Use it 4+ hours a night on at least 21 nights in a row of 30 (70% of nights).
- That 30-night stretch can be any 30 days in a row within your first 90 days (3 months) of therapy.
- 3 hours 59 minutes doesn't count. A night counts only if your machine logs 4 hours or more.
- Miss it, and Medicare may stop paying. You may need to start over with a new sleep evaluation, or pay for the machine yourself.
This is Medicare's rule. Many private insurers use a similar rule, but not all. Check with your equipment supplier.
Check your nights
If you're behind: what usually helps
- Call your equipment supplier or sleep doctor first. Mask leaks, a dry mouth or pressure that feels too strong are common, fixable problems. Never change your pressure settings yourself.
- Try a different mask. Many suppliers let you swap masks early in therapy. Ask what your plan covers.
- Wear it while awake. Practicing with the mask on while reading or watching TV can make it feel normal faster.
- Put it back on. If you take it off in the night, put it back on. Every minute counts toward your 4 hours.
- Ask about humidity. A dry nose or mouth is a common reason people quit. Your supplier can help with the humidifier and tubing.
This calculator isn't medical advice. It estimates progress toward a coverage rule; it can't tell you whether your therapy is working. Your supplier's official report is what counts. Talk to your doctor before changing anything about your treatment.
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Sources
- Centers for Medicare & Medicaid Services, LCD L33718: Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea.