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    • "Write Right Tool"
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      • CPAP
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    • Contact

  • Home
  • "Write Right Tool"
  • Choose Equipment Type
    • CPAP
    • BIPAP
    • Respiratory Assist Device
    • Oxygen
    • Hospital Beds
    • Wheelchairs
    • Patient Lift
  • Contact

FAX 866-372-0380 or SECURE EMAIL cs@hcshme.com

FAX 866-372-0380 or SECURE EMAIL cs@hcshme.com

FAX 866-372-0380 or SECURE EMAIL cs@hcshme.com

FAX 866-372-0380 or SECURE EMAIL cs@hcshme.com

FAX 866-372-0380 or SECURE EMAIL cs@hcshme.com

FAX 866-372-0380 or SECURE EMAIL cs@hcshme.com

Positive Airway Pressure Devices

AUTO CPAP/CPAP

INITIAL COVERAGE:


In this policy, the term PAP (positive airway pressure) device will refer to a single-level continuous positive airway pressure device (E0601) in the treatment of obstructive sleep apnea.


1. An E0601 device is covered for the treatment of obstructive sleep apnea (OSA) if criteria A – C are met:


A. The beneficiary has an in-person clinical evaluation by the treating practitioner prior to the sleep test to assess the beneficiary for obstructive sleep apnea.


B. The beneficiary has a sleep test (as defined below) that meets either of the following criteria (1 or 2):

1. The apnea-hypopnea index (AHI) or Respiratory Disturbance Index (RDI) is greater than or equal to 15 events per hour with a minimum of 30 events; or,


2. The AHI or RDI is greater than or equal to 5 and less than or equal to 14 events per hour with a minimum of 10 events and documentation of:

  • Excessive daytime sleepiness, impaired cognition, mood disorders, or insomnia; or,
  • Hypertension, ischemic heart disease, or history of stroke.


C.  The beneficiary and/or their caregiver has received instruction from the supplier of the device in the proper use and care of the equipment.


Replacement:


If a PAP device is replaced following the 5 year RUL, there must be an in-person evaluation by their treating practitioner that documents that the beneficiary continues to use and benefit from the PAP device. There is no requirement for a new sleep test or trial period. 


Restart:


Beneficiaries who fail the initial 12 week trial are eligible to re-qualify for a PAP device but must have both:


1. In-person clinical re-evaluation by the treating practitioner to determine the etiology of the failure to respond to PAP therapy; and,

2. Repeat sleep test in a facility-based setting (Type 1 study). This may be a repeat diagnostic, titration or split-night study.


Click Here for Medicare Coverage Resources Website

Accessories

Full Face Mask

Nasal Pillow Mask

Full Face Mask

(A7030) Coverage for this accessory met with device criteria

Nasal Mask

Nasal Pillow Mask

Full Face Mask

(A7034) Coverage for this accessory met with device criteria

Nasal Pillow Mask

Nasal Pillow Mask

Nasal Pillow Mask

(A7034) Coverage for this accessory met with device criteria

Headgear

Full Face Cushion

Nasal Pillow Mask

 (A7035) Coverage for this accessory met with device criteria

Full Face Cushion

Full Face Cushion

Full Face Cushion

(A7031) Coverage for this accessory met with device criteria

Nasal Cushion

Full Face Cushion

Full Face Cushion

(A7032) Coverage for this accessory met with device criteria 

Nasal Pillow

Heated Tubing

Heated Tubing

(A7033) Coverage for this accessory met with device criteria

Heated Tubing

Heated Tubing

Heated Tubing

(A4604) Coverage for this accessory met with device criteria

Water Chamber

Heated Tubing

Water Chamber

(A7046) Coverage for this accessory met with device criteria

Filters

Filters

Water Chamber

(A7038/A7039 Coverage for this accessory met with device criteria

Prescription Template

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FAX 866-372-0380 or SECURE EMAIL cs@hcshme.com

FAX 866-372-0380 or SECURE EMAIL cs@hcshme.com

FAX 866-372-0380 or SECURE EMAIL cs@hcshme.com

FAX 866-372-0380 or SECURE EMAIL cs@hcshme.com

FAX 866-372-0380 or SECURE EMAIL cs@hcshme.com

FAX 866-372-0380 or SECURE EMAIL cs@hcshme.com

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  • CPAP
  • BIPAP
  • Respiratory Assist Device
  • Oxygen
  • Hospital Beds
  • Wheelchairs
  • Patient Lift

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