Medicare PAP supply replacement schedule
Medicare's PAP policy (LCD L33718) lists the usual maximum quantity of each accessory it considers reasonable and necessary. Many suppliers and private insurers use the same schedule, but check your own plan.
| HCPCS code | Item | Usual maximum |
|---|---|---|
| A7030 | Full face mask | 1 per 3 months |
| A7031 | Full face mask replacement cushion | 1 per month |
| A7034 | Nasal interface (mask or cannula type), with or without head strap | 1 per 3 months |
| A7032 | Nasal mask replacement cushion | 2 per month |
| A7033 | Nasal pillows replacement (per pair) | 2 per month |
| A7027 | Combination oral/nasal mask | 1 per 3 months |
| A7028 | Oral cushion for combination oral/nasal mask | 2 per month |
| A7029 | Nasal pillows for combination oral/nasal mask (per pair) | 2 per month |
| A7035 | Headgear | 1 per 6 months |
| A7036 | Chinstrap | 1 per 6 months |
| A7037 | Tubing (standard) | 1 per 3 months |
| A4604 | Tubing with integrated heating element | 1 per 3 months |
| A7038 | Filter, disposable | 2 per month |
| A7039 | Filter, non-disposable | 1 per 6 months |
| A7046 | Humidifier water chamber, replacement | 1 per 6 months |
Notes
- These are usual maximums, not automatic entitlements. Medicare denies quantities above them as not reasonable and necessary, and supplies are billed based on expected use, not past use.
- Accessories are covered only when the coverage criteria for the PAP device are met.
- Medicare's PAP policy article states that mask liners are not interfaces and should not be billed as replacement cushions.
- The PAP machine itself has a 5 year reasonable useful lifetime under Medicare.
- Medicare Advantage and private plans often use similar schedules but can differ. Check your plan documents or ask your supplier.
- Item names are plain-English versions of the HCPCS descriptors. Schedule as listed in LCD L33718 when checked in October 2026.
Sources
More reference tables
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