No, Medicare in Australia does not cover the cost of a CPAP machine. The device sits outside the Medicare Benefits Schedule, and there is no national rebate for buying one. What Medicare does pay for is the diagnostic pathway that gets you to a prescription: the sleep study and the specialist consultations. Funding for the machine itself comes from somewhere else, usually a state or territory loan program, the Department of Veterans’ Affairs, private health insurance extras, or in narrow cases the NDIS.
What Medicare Will Pay For
Medicare rebates the diagnosis, not the equipment. An in-laboratory diagnostic sleep study under MBS Item 12203 has a schedule fee of $685.95, with a Medicare benefit of either $514.50 or $583.10 depending on whether the 75% or 85% rate applies.1Australian Government Department of Health. MBS Item 12203 A home-based study under Item 12250 attracts a rebate of $335.30. Treatment initiation studies (Item 12204) and follow-up studies after symptom recurrence (Item 12205) each carry a $588.00 rebate.2RACGP. Respiratory Function and Sleep Studies Each sleep study item can only be billed once in any 12-month period.3Australian Government Department of Health. Factsheet – Sleep Disorders
To get a Medicare-funded sleep study through a GP referral, an adult patient needs an Epworth Sleepiness Scale score of 8 or higher, plus a positive result on at least one additional screening tool: a STOP-Bang score of 4 or more, an OSA-50 score of 5 or more, or a high-risk Berlin Questionnaire result.2RACGP. Respiratory Function and Sleep Studies If you don’t meet those thresholds, a sleep specialist or respiratory physician can still order a study based on clinical judgment.3Australian Government Department of Health. Factsheet – Sleep Disorders
Specialist consultations are rebated too. An initial consultation with a respiratory or sleep physician under MBS Item 110 attracts a $151.90 rebate, a subsequent review under Item 116 attracts $76.00, and a complex initial consultation under Item 132 attracts $265.60.4SA Medical Specialists. Fee Schedule November 2025 Telehealth equivalents exist for each.
State and Territory Equipment Programs
Each state and territory runs its own CPAP loan or subsidy scheme. Eligibility generally requires a Pensioner Concession Card, Health Care Card, or DVA card, plus a confirmed diagnosis of moderate-to-severe obstructive sleep apnea. Most programs lend a basic fixed-pressure machine rather than giving you one outright, and you have to meet ongoing use targets to keep it.5The CPAP Clinic. Does Medicare Cover CPAP Machines
In New South Wales, the EnableNSW Home Respiratory Program supplies machines to eligible residents. You’ll need a medical referral, a sleep study report, concession card proof, and a trial period of roughly 4 to 12 weeks showing adequate compliance. The program typically covers the machine and one mask interface, with co-payments of $50 to $300 in some cases.6EnableNSW. Home Respiratory Program7The CPAP Clinic. Government Funded CPAP Machine
In Queensland, the Queensland Health Sleep Disorders Program provides long-term CPAP loans. You must hold a Pensioner Concession Card, Health Care Card, or DVA white card, live permanently in Queensland, and be managed by a sleep physician at a QHSDP Prescriber Centre. Before a loan device is issued, you rent a machine at your own expense for a minimum two-month home trial and must demonstrate average use of at least four hours per night. Masks, headgear, and other accessories (typically $180 to $350) are bought separately.8Queensland Government. Queensland Health Sleep Disorders Program
In Victoria, CPAP machines are not explicitly listed in the published equipment categories of the Victorian Aids and Equipment Program, which focuses on items like wheelchairs, pressure-reducing mattresses, and continence aids. If you’re seeking CPAP support, contact the State-wide Equipment Program directly on 1300 747 937 to confirm whether current guidelines cover it.9Victorian Government Department of Health. Victorian Aids and Equipment Program
In Tasmania, the Continuous Positive Airways Pressure Program supplies equipment to residents with a sleep specialist prescription and an eligible concession card, operating through hospital respiratory departments in Hobart and Launceston.10Tasmanian Government. Continuous Positive Airways Pressure Program
Arrangements in Western Australia, South Australia, the ACT, and the Northern Territory are not confirmed in the sources available. If you live in those jurisdictions, contact your local public hospital sleep clinic or state health department about any available support.
Veterans: DVA Coverage
Eligible veterans can get a fully funded CPAP machine through the DVA’s Rehabilitation Appliances Program. Gold Card holders need a clinical assessment confirming the need; White Card holders need an accepted condition linked to the equipment. A polysomnographic sleep study is required before prescription, and the prescription must come from a respiratory physician, ENT specialist, or respiratory clinic.11Department of Veterans’ Affairs. Non-Invasive Ventilation Positive Airway Pressure
New users complete a trial of up to 30 days, with up to three trials permitted, to confirm the therapy is tolerated. DVA also covers consumables like masks, filters, and hoses, and can arrange short-term rental of a travel CPAP for up to three months during travel.12Department of Veterans’ Affairs. Travel CPAP Short Term Rental UV sanitisers and generators are not funded.11Department of Veterans’ Affairs. Non-Invasive Ventilation Positive Airway Pressure
Private Health Insurance
If you don’t qualify for a state program and don’t want to pay the full retail price, private health insurance is the most common path. CPAP machines fall under extras cover, not hospital cover, and rebates vary considerably between funds and policy tiers.13ResMed Australia. Are CPAP Machines Covered by Medicare or Private Health Insurance Typical rebates sit somewhere between $500 and $1,000 depending on your level of extras.14The CPAP Clinic. Does Medicare Cover CPAP Equipment
Rules differ by fund. Bupa, for example, classifies CPAP machines under its Health Aids and Appliances extras benefit. New members face a 12-month waiting period before claiming on a purchase, benefits are limited to one machine per person every two years, consumables like masks and straps are not covered, and second-hand or refurbished devices are excluded.15Bupa Australia. Health Aids and Appliances Most funds want a confirmed diagnosis, and some require a doctor’s letter of recommendation.13ResMed Australia. Are CPAP Machines Covered by Medicare or Private Health Insurance Check your own policy before you buy.
NDIS: A Narrow Pathway
The NDIS can fund a CPAP machine, but only where the device is necessary to manage a participant’s disability. Sleep apnea by itself is not enough. The need has to be tied to a functional issue arising from an NDIS-recognised disability, such as a psychosocial, neurological, or physical condition that sleep apnea makes worse.16ResMed Australia. CPAP Cover NDIS You’ll need clinical reports and specialist referrals establishing the link, and the question should go to your planner or support coordinator.
Help With Running Costs
Concession card holders who run a CPAP machine at home can claim the Essential Medical Equipment Payment. It’s an annual $196 payment from Services Australia to help with the electricity cost of medically necessary equipment, and “positive airways pressure device” is on the eligible list.17Services Australia. Eligible Equipment for Essential Medical Equipment Payment To qualify you need a Commonwealth Concession Card, a medical reason for the equipment, and to be the one paying for the electricity to run it.18Services Australia. Who Can Get Essential Medical Equipment Payment and How Much You Can Get Once approved, the payment continues automatically each year unless your circumstances change.
What You’ll Pay Out of Pocket
Buying without a subsidy, prices typically run from around $700 for a basic fixed-pressure machine to over $2,000 for an auto-adjusting device with advanced features.19Health Deal. CPAP Machines and Sleep Apnea Treatment Insurance Coverage Guide A ResMed AirSense 11 AutoSet retails around $1,799; a compact AirMini travel device sits near $1,200. Rental and subscription options also exist, with trials from about $35 and subscriptions starting around $19.20ResMed Australia. Sleep Apnea CPAP Machines
The machine isn’t the only cost. Mask cushions need replacing every one to six months depending on material, headgear every six months, tubing every 12 months, and filters every two to three months.21ResMed Australia. Heres How Often You Should Be Replacing Your CPAP Gear Machines themselves last three to five years, and government-subsidised programs generally allow replacement every five years.5The CPAP Clinic. Does Medicare Cover CPAP Machines
CPAP machines are not tax deductible. The ATO treats medical aids and appliances as private expenses not incurred in earning assessable income.22Australian Taxation Office. Medical and Dental Expenses, Vaccinations and COVID-19 Tests
A Note on US Medicare
Confusion on this topic often comes from the US system, where Medicare does cover CPAP therapy as durable medical equipment under Part B.23Medicare.gov. Continuous Positive Airway Pressure Devices Australia’s Medicare has no equivalent arrangement. The equipment sits entirely outside the national benefits schedule here.5The CPAP Clinic. Does Medicare Cover CPAP Machines