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General information about a billing code, not medical advice. Whether a person needs or qualifies for a device is decided by their treating practitioner and their payer.
Short answer
HCPCS E0601 is the code for a continuous positive airway pressure (CPAP) device, the machine itself. Under Medicare policy, auto-titrating single-level CPAP devices are also billed with E0601. Masks, cushions and tubing are separate supply codes. Coverage for obstructive sleep apnea (OSA) is set out in a different document, the LCD L33718, and it depends on a sleep test, a documented evaluation and later adherence data.
Definition and scope
HCPCS (Healthcare Common Procedure Coding System) Level II codes identify supplies and equipment such as durable medical equipment. E0601 identifies the CPAP device. It does not describe the accessories used with it, which have their own codes and their own billing units. For how HCPCS differs from CPT, see HCPCS vs CPT codes; for what the machine is, see what a CPAP machine is.
Two Medicare documents are easy to confuse. The Policy Article A52467 is the coding document: it says which code to use. The LCD L33718, "Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea", is the coverage document: it says when the device is reasonable and necessary. Both are issued for the DME MAC jurisdictions.
E0601 vs E0470 vs E0471
These three codes are PAP device codes that the policy documents treat in sequence rather than as interchangeable choices.
| Code | What the policy documents say | OSA coverage position in LCD L33718 |
|---|---|---|
| E0601 | Used for auto-titrating single-level CPAP devices (Policy Article A52467). | The starting device for OSA when the coverage criteria are met. |
| E0470 | Bi-level device without backup rate; allows separate inspiratory and expiratory pressures. | Covered for OSA only after E0601 has been tried and proven ineffective, in a facility or home trial. |
| E0471 | Same pressure capability as E0470, plus a timed backup feature. | Not reasonable and necessary when the primary diagnosis is OSA. |
Source: LCD L33718 and Policy Article A52467, both checked 2026-10-30.
The coverage checklist (LCD L33718)
The LCD states the following conditions for E0601 in OSA. This is a summary of the policy text, not a substitute for it.
Before and at initial coverage
- An in-person clinical evaluation by the treating practitioner takes place before the sleep test.
- The sleep test shows an AHI/RDI of 15 or more events per hour with at least 30 events, or an AHI/RDI of 5 to 14 with at least 10 events plus a documented condition: excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or hypertension, ischemic heart disease or prior stroke.
- The beneficiary or caregiver has been instructed by the supplier in use and care of the device.
Continued coverage
- A clinical re-evaluation occurs no sooner than the 31st day and no later than the 91st day after therapy starts. Note the 91, not 90.
- The re-evaluation is in person and documents that symptoms improved.
- Objective adherence data are reviewed. Adherence means use of 4 hours or more per night on 70 percent of nights in a consecutive 30-day period within the first three months.
- If the initial trial fails, requalification requires a new in-person re-evaluation and a repeat facility-based (Type I) sleep test.
What is billed separately
- Humidifiers: E0561 (non-heated) and E0562 (heated) are covered when ordered by the treating practitioner for use with a covered E0470 or E0601 (LCD L33718).
- Mask and supply codes: Policy Article A52467 states accessories are payable at the time of initial issue and when replaced. A7032 is counted "each", A7033 as a "pair", and a combination oral/nasal mask (A7027) counts the oral and nasal parts as one unit.
The article does not give a replacement schedule, so none is stated here. For the hardware around the machine, see CPAP accessories and CPAP hose.
Where it matters for sleep labs and clinics
The checklist above shows that the timing of the clinical evaluation relative to the sleep test, and the 31st to 91st day window, are documentation points that sit with the treating practitioner and the supplier, not with the code. Staff reconciling orders against equipment can use the sleep clinic supply checklist, and the broader Medicare DME coverage guide and DME list place E0601 among other equipment. Other DME codes follow their own policies; for example, see the shower chair HCPCS code guide for E0240.
Common misunderstandings
- "E0601 covers the whole setup." It identifies the device only; masks, cushions and tubing carry separate codes and units.
- "A bi-level machine is the upgrade." For OSA, the LCD requires E0601 to have been tried and proven ineffective before E0470, and does not treat E0471 as reasonable and necessary when OSA is the primary diagnosis.
- "The coding article sets coverage." A52467 covers coding; L33718 covers coverage.
- "Coverage is decided at the sleep test." Continued coverage depends on re-evaluation and adherence data in the first three months.
FAQ
What is HCPCS E0601?
It is the code for a CPAP device, the machine. Medicare’s Policy Article A52467 directs auto-titrating single-level CPAP devices to it.
Does E0601 include the mask and tubing?
No. Accessories have separate codes, such as A7032 (each) and A7033 (pair), with their own units.
What adherence does Medicare require for continued CPAP coverage?
The LCD defines adherence as use of 4 hours or more per night on 70 percent of nights in a consecutive 30-day period within the first three months.
When is the follow-up evaluation due?
No sooner than the 31st day and no later than the 91st day after therapy begins, in person, per LCD L33718.
Which document covers coding and which covers coverage?
Policy Article A52467 covers coding; LCD L33718 covers coverage.
Sources
- CMS Medicare Coverage Database, LCD L33718, Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea, revision effective for services on or after 2024-01-01; checked 2026-10-30.
- CMS Medicare Coverage Database, Policy Article A52467, Positive Airway Pressure (PAP) Devices coding, revision R15 effective 2021-08-08, public version updated 2024-05-08; checked 2026-10-30.
