Medicare Coverage for PAP Devices: Understanding the LCD and Policy Article

Positive Airway Pressure (PAP) devices are a key treatment option for beneficiaries diagnosed with obstructive sleep apnea (OSA). Medicare outlines the coverage requirements for these devices through two primary documents: the Local Coverage Determination (LCD) and the Policy Article (PA). Together, these resources define the clinical criteria, documentation standards, and billing expectations that suppliers must follow to ensure proper reimbursement.

Overview of the LCD for PAP Devices

The Local Coverage Determination (LCD) for PAP devices establishes the clinical indications and coverage criteria that must be met before Medicare will reimburse for a PAP device. The following is outlined within the LCD:

  • Coverage criteria for PAP therapy
  • Reference to the National Coverage Determination (NCD 240.4) for CPAP therapy
  • Requirements for initial coverage and continued coverage
  • Documentation expectations for medical necessity

These elements ensure that PAP therapy is provided only when clinically appropriate and supported by adequate medical documentation.

The Policy Article (PA): Documentation & Billing Requirements

The Policy Article (PA) supplements the LCD by detailing coding, and documentation requirements for PAP devices. The PA includes:

  • Coding guidelines for PAP devices and accessories
  • Detailed documentation requirements for suppliers
  • Clarification of continued medical necessity documentation
  • Instructions for clinicians regarding chart notes and follow‑up documentation

The PA ensures that suppliers understand not only what is required clinically, but also how to document and bill correctly to avoid denials.

Key Documentation Requirements

Noridian provides several clinician tools to support compliance, including:

  • Clinician Checklist - PAP
  • Clinician Letters for Documentation of Continued Medical Necessity
  • Standard Documentation Requirements Policy Article - A55426

These resources help ensure that suppliers gather all required information before submitting claims, reducing the risk of audits or claim denials.

Noridian PAP Device Resources

Additional resources can be found on the Noridian Medicare website under the Browse by DMEPOS Category > Positive Airway Pressure (PAP) Devices.

Last Updated Mar 26 , 2026