This work investigates the influence of water compressibility on pressure pulsations induced by rotor-stator interaction (RSI) in hydraulic machinery, using the commercial CFD solver ANSYS-CFX. A pipe flow example with harmonic velocity excitation at the inlet plane is simulated using different grid densities and time step sizes. Results are compared with a validated code for hydraulic networks (SIMSEN). Subsequently, the solution procedure is applied to a simplified 2.5-dimensional pump-turbine configuration in prototype with different speeds of sound as well as in model scale with an adapted speed of sound. Pressure fluctuations are compared with numerical and experimental data based on prototype scale. The good agreement indicates that the scaling of acoustic effects with an adapted speed of sound works well. With respect to pressure fluctuation amplitudes along the centerline of runner channels, incompressible solutions exhibit a linear decrease while compressible solutions exhibit sinusoidal distributions with maximum values at half the channel length, coinciding with analytical solutions of one-dimensional acoustics. Furthermore, in compressible simulation the amplification of pressure fluctuations is observed from the inlet of stay vane channels to the spiral case wall. Finally, the procedure is applied to a three-dimensional pump configuration in model scale with adapted speed of sound. Normalized Pressure fluctuations are compared with results from prototype measurements. Compared to incompressible computations, compressible simulations provide similar pressure fluctuations in vaneless space, but pressure fluctuations in spiral case and penstock may be much higher.