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CPAP Equipment Request Form

Northwest Pulmonary and Sleep Medicine in Crystal Lake and South Barrington, Illinois wants you to be satisfied with the CPAP equipment we recommend and provide to you for your continued health and well-being. If you have commercial insurance, please use the online form below to send us a request for supplies, or ask questions about your durable medical equipment. Please note, due to Medicare rules, we are unable to supply durable medical equipment to Medicare patients. You can also email us at


A4604  CPAP Tubing With Heating Element: 1 per 3 months

A7027 Combination Oral/Nasal CPAP Mask: 1 per 3 months

A7028 Replacement Oral Cushion for Oral/Nasal Mask: 2 per 1 month

A7029 Replacement Nasal Pillows for Oral/Nasal Mask, One Pair: 2 per 1 month

A7030 Full Face Mask: 1 per 3 months

A7031 Full Face Mask Interface: 1 per 1 month

A7032: Cushion for Nasal Mask Interface: 2 per 1 month

A7033 Nasal Pillows: 2 per 1 month

A7034 Nasal Interface: 1 per 3 months

A7035 Headgear: 1 per 6 months

A7036 Chinstrap: 1 per 6 months

A7037 Tubing: 1 per 3 months

A7038 Disposable Filter: 2 per 1 month

A7039 Nondisposable Filter: 1 per 6 months

A7046 Humidifier Water Chamber: 1 per 6 months

*Please check with your own insurance carrier to verify benefits.*