Does Insurance Reimburse for Refurbished CPAP and BiPAP Machines?

If you’ve been prescribed a CPAP or BiPAP machine, one of the first questions you may ask is: will my insurance cover it? And more specifically, what about refurbished equipment?

At Outfront Medical, we specialize in providing safe, reliable, and patient-ready refurbished medical equipment, including PAP therapy devices. Understanding how Medicare, Medicaid, and private health insurance handle reimbursement for refurbished CPAP and BiPAP machines can help you make an informed decision.

Medicare

Medicare classifies CPAP and BiPAP devices as durable medical equipment (DME) under Part B. In most cases, Medicare coverage works like this:

• Trial Period – Medicare typically covers an initial 12-week trial rental period if you have a prescription and a confirmed diagnosis of obstructive sleep apnea.
• Extended Coverage – If your doctor confirms that the therapy is helping and you are using the machine as prescribed, Medicare continues coverage, usually under a capped rental that leads to eventual ownership.
• Replacement Rules – Medicare normally considers the “reasonable useful lifetime” of a PAP device to be about five years. Replacements before that time are only covered under certain circumstances (e.g., if the device is lost, stolen, or irreparably damaged).
• Refurbished Equipment – While Medicare doesn’t explicitly state “new only,” suppliers billing for used or refurbished equipment may need to apply the correct coding modifiers. Ultimately, it depends on the supplier’s willingness to provide refurbished equipment that meets Medicare’s standards.

Medicaid

Medicaid coverage varies from state to state, since each program sets its own rules for DME. Many Medicaid plans do cover PAP therapy devices, but criteria can be stricter than Medicare. Pre-authorization, proof of medical necessity, and documentation of usage are often required.

When it comes to refurbished equipment, the answer depends on the state’s Medicaid policies and whether the contracted supplier is allowed to provide refurbished units. Some states permit this if the equipment is safe and functional, while others may require new devices only.

Private Health Insurance

Commercial or “standard” health insurance policies are often less consistent than Medicare. Key factors include:

• Policy Language – Some plans only reimburse for new equipment, while others may allow used/refurbished devices if they meet medical necessity requirements.
• Supplier Contracts – Even if your plan allows refurbished machines, the DME supplier must be in-network and able to bill properly for refurbished units.
• Usage and Documentation – Just like Medicare, private insurers often require proof of medical necessity and compliance with therapy before continuing coverage.
• Billing Modifiers – Many insurers do have provisions for “used DME,” but proper billing procedures must be followed.

What This Means for You

If you are considering a refurbished CPAP or BiPAP machine, reimbursement is possible — but it depends on your insurance provider, your plan details, and your supplier.

• Medicare: Often the most straightforward path, but the supplier must bill correctly.
• Medicaid: Varies by state; check your state’s program guidelines.
• Private Insurance: Depends on policy language and supplier agreements.

At Outfront Medical, all our refurbished equipment is thoroughly tested, cleaned, and patient-ready. If you’re unsure whether your insurance will reimburse for a refurbished device, we recommend checking directly with your insurance provider and discussing options with your physician.

Key Takeaway: Refurbished CPAP and BiPAP machines can be a safe, cost-effective solution. While insurance reimbursement is not always guaranteed, many programs will consider coverage when proper procedures and documentation are followed.