Aetna clarifies use of G codes for CPAP claims
By HME News Staff
Updated 11:23 AM CST, Thu December 18, 2025
HARTFORD, Conn. – Aetna has clarified that, while durable medical equipment (DME) providers do not use G codes for traditional Medicare fee-for-service claims, it believes G codes can be used for commercial or Medicare Advantage claims, according to a bulletin from AAHomecare. The clarification is in response to industry concerns that the insurer was once again trying to require adherence codes G8851, G8854 and G8855 for reimbursement for CPAP devices or supplies, something the industry has pushed back on more than once, saying the codes can only be billed by clinicians, not DME providers. In October, Aetna issued a list of upcoming policy changes and reminders that stated: “Beginning December 1, 2025, we’ll no longer reimburse the CPAP device or the supplies unless you document positive airway pressure therapy using adherence codes G8851, G8854 and G8855.” Aetna has confirmed they acknowledge and accept the KX modifier to confirm adherence but strongly recommend that DME suppliers use G codes, as they feel these codes provide additional data. AAHomecare is asking for Aetna to issue a revised policy to be published with this information.
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