Aetna tries to change coding requirements for CPAP devices – again 

HARTFORD, Conn. - Aetna is once again trying to require adherence codes G8851, G8854 and G8855 for reimbursement for CPAP devices or supplies, the Midwest Association for Medical Equipment Services & Suppliers (MAMES) reports. 

The insurer tried the same move earlier this year, but after the HME industry pushed back, saying providers can’t bill these codes, it pulled back the change. 

In an October 2025 list of upcoming policy changes and reminders, however, Aetna states: 

“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 also included the following notes for providers in Washington state, Texas, Maine and Vermont. 

Note to Washington State providers: For commercial plans, your effective date for changes described in this article will be communicated to you following regulatory review. 

Note to Texas providers: Changes described in this article will be implemented for fully insured plans written in the state of Texas only if such changes are in accordance with applicable regulatory requirements. Changes for all other plans will be as outlined in this article. 

Note to Maine and Vermont providers: For commercial plans, your effective date for routine changes described in this article will be the statutory date of January 1, April 1, July 1 or October 1, whichever date follows the effective date(s) referred to in this article. Changes required by state or federal law, or pursuant to revisions of Current Procedural Terminology (CPT®) codes published by the American Medical Association, may be effective outside the statutory dates outlined above. 

In a previous letter to Aetna, AAHomecare pointed out that “G” codes identify health care procedures and services that may not have assigned CPT codes and are not listed in the PDAC, which identifies HCPCS codes that are billable by DME suppliers.