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Frequently Asked Questions

What documentation is required to process a CPAP order?

Most insurance plans require:

  • A diagnostic sleep study (in-lab PSG or approved HST)

  • A signed and dated prescription

  • Recent clinical notes supporting medical necessity

  • Face-to-face visit documentation (within required timeframe)

Our team reviews all documentation before submission to avoid delays.

What must be included on the CPAP prescription?

The prescription should include:

  • Patient name and DOB

  • Diagnosis (e.g., OSA with ICD-10 code)

  • CPAP/APAP/BiPAP settings (or pressure range)

  • Length of need (often lifetime)

  • Physician signature and date

If any information is missing, we will notify your office immediately.

We cannot locate our patient's past sleep study, can they still receive a new PAP device?

Insurance companies will typically require SleepWell to have documentation on file of a sleep study in order to provide a replacement device. SleepWell can assist in locating an older study, but if one is not found then we would recommend providing a home sleep test. This is not a requirement for cash pay patients.

We cannot schedule our patient for their 31-90 day follow up within the timeframe required, is this going to be an issue for them?
It would be ideal to schedule them within this timeframe, but they can still receive insurance coverage if the appointment is outside of this timeframe.
Does the insurance require that compliance is met when our patient completes their 31-90 day follow-up?
Yes. In order for the follow-up to qualify for most insurances, it must occur after the patient has achieved compliant use of their PAP. We recommend scheduling them again or rescheduling if this appointment occurred prior to meeting the usage requirement. The follow up should document that the usage requirement is met and that the patient is benefitting from its use.
What is the requirement for extending the 90 day trial period for meeting compliance?
If your patient is non-compliant and requesting an extension, they should have an appointment with the physician to discuss the reasons. Most insurances require the completion of an in-lab sleep study to extend compliance. The sleep study and notes for the visit are needed by Sleep Source, and the patient will have another 90 days to achieve compliance once these are sent. Patients will be charged and expected to pay that balance unless they achieve compliance in the extension period.
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