Are CPAP Machines and Supplies FSA Eligible?

A Flexible Spending Account (FSA) is an employer-sponsored benefit that allows individuals to set aside pre-tax money for qualified healthcare expenses, helping cover out-of-pocket medical costs. Continuous Positive Airway Pressure (CPAP) machines are medical devices commonly prescribed to individuals diagnosed with sleep apnea, a condition characterized by interrupted breathing during sleep.

Understanding CPAP Eligibility for FSA

CPAP machines are generally eligible for reimbursement through an FSA because they are considered medical equipment necessary for treating a diagnosed health condition. IRS guidelines under Internal Revenue Code Section 213 define eligible medical expenses as costs paid for the diagnosis, cure, mitigation, treatment, or prevention of disease. This definition includes durable medical equipment like CPAP devices.

Associated supplies and accessories also qualify for FSA reimbursement. This includes items such as CPAP masks, headgear, tubing, filters, humidifiers, and certain cleaning solutions specifically designed for CPAP equipment. A prescription or a Letter of Medical Necessity (LMN) from a qualified healthcare provider is usually required for CPAP machines and supplies.

Required Documentation for Reimbursement

When seeking reimbursement for CPAP-related expenses, you must provide detailed, itemized receipts for all purchases. These receipts should clearly display the date of service or purchase, the name of the vendor, a specific description of the item or service, and the amount paid.

The prescription or Letter of Medical Necessity (LMN) is a foundational piece of documentation. An LMN serves as documentation from your doctor explaining why a particular item or service is recommended to treat a specific health condition. This document helps confirm the purchase is for medical purposes.

The letter must specify the diagnosed medical condition requiring CPAP treatment, describe the recommended treatment including the specific device or supplies, and indicate the duration for which the treatment is needed. The LMN substantiates the medical necessity of the expense, aligning it with IRS definitions for qualified medical costs. Some FSA administrators may also accept an Explanation of Benefits (EOB) form from your insurance provider.

The FSA Reimbursement Process

Once all necessary documentation has been gathered, you can initiate the reimbursement process for your CPAP expenses. You can submit claims online, via mobile applications, or by mail, typically by uploading digital copies of your itemized receipts and any required medical necessity documentation.

After submission, the FSA administrator reviews the claim and supporting documents to ensure compliance with IRS regulations and plan rules. Approved reimbursements are commonly issued via direct deposit or by check. Retain your receipts in case substantiation is requested.