November 8, 2019

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.

Humana Military is actively working with Defense Health Agency (DHA) to clarify billing guidelines around this updated benefit.

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