Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Thursday, July 15, 2010

Lexi has left a new comment on your post "New Medicare Guidelines for CPAP":

We are currently doing research on CPAP compliance and Medicare converage. However, I cannot find a Medicare definition of CPAP Compliance. Could you please tell me where you found this information where Medicare defined CPAP compliance as, "at least 4 hours a night and wear CPAP 70% of the time for a 30 consequtive day period"?

Thank you in advance,
Alexia Adams

Dear Lexi,
I cannnot reply directly as you did not leave an e-mail address

This is from ResMed "CONTINUED COVERAGE BEYOND THE FIRST THREE MONTHS OF THERAPY:
Continued coverage of a PAP device (E0470 or E0601) beyond the first three months of therapy requires that, no sooner than the 31st day but no later than the 91st day after initiating therapy,
documentation of clinical benefit is demonstrated by:
Face-to-face clinical re-evaluation by the treating physician with documentation that symptoms of obstructive sleep apnea are improved; and,
Objective evidence of adherence to use of the PAP device reviewed by the treating physician.
*************
********Adherence to therapy is defined as use of PAP > 4 hours per night on 70% of nights during a consecutive thirty (30) day period anytime during the first three (3) months of initial usage.
If the above criteria are not met, continued coverage of a PAP device and related accessories will be denied as not medically necessary.
Beneficiaries who fail the initial 12 week trial are eligible to requalify for a PAP device but must have both:
Face-to-face clinical re-evaluation by the treating physician to determine the etiology of the failure to respond to PAP therapy; and,
Repeat sleep test in a facility-based setting (Type 1 study)." It came from
http://www.resmed.com/us/dealers/reimbursement/cpap.html?nc=dealers
For more info use Google search "medicare cpap coverage minimal usage for coverage" it was hard to find, I know it from many different sources.

Medicare has issued these new rules because they are tired for paying for CPAP that is not used. Statistics show only 60% of patients use CPAP long term and the fact that 4 hours a night is not acceptable treatment but it is certainly better than no treatment. Sleep Apnea is a dangerous and serious condition and most heart attacks and strokes are in the early morning hours when patients have abandoed their CPAP.

Dr Shapira

Dr Shapira

Labels: , , , , , ,

posted by Dr Shapira at 6:54 PM