July 8, 2020

Under TRICARE’s Durable Medical Equipment (DME) benefit, beneficiaries who have been diagnosed with obstructive sleep apnea syndrome or respiratory insufficiency, may be eligible to receive a Continuous Positive Airway Pressure (CPAP) machine. Prior authorization is required for this limited benefit.

TRICARE may also cover a portable CPAP machine for Active Duty Service Members (ADSM) with a referral that states the beneficiary:

• has a diagnosis of obstructive sleep apnea
• travels on official business at least three days per month, or is being deployed
• is not retiring or separating from the military within the year

Please note:

• The portable device must have humidification and battery capability.
• If the beneficiary has a standard CPAP machine, a portable machine is covered if the above conditions are met. TRICARE will not authorize a standard CPAP machine if the beneficiary already has a portable machine.

Billing guidelines:

Please provide a description and bill under Healthcare Common Procedure Coding System (HCPCS) code E1399.

See additional information about TRICARE CPAP machine benefit, conditions and exclusions