Medicare Announces Final Coverage Policy For Continuous Positive Airway Pressure Therapy For Obstructive Sleep Apnea

The Centers for Medicare & Medicaid Services (CMS) expanded Medicare coverage for the continuous positive airway pressure (CPAP) devices to beneficiaries who were diagnosed with a test at home sleeping with obstructive sleep apnea. CMS also announced changes to simplify certain requirements.

Obstructive Sleep Apnea (OSA) is a state in the period of temporary suspension of breathing (apnea) during sleep. In most cases, OSA is diagnosed by counting the number of sleep disorders, during a specified time interval. Up to four million Medicare beneficiaries in May suffer from some form of OSA.

The CPAP devices provide compressed air through a face mask to prevent breathing during sleep passages open. Medicare's current policy CPAP provides coverage only for the beneficiaries, the OSA diagnosed with a certain type of sleep test called polysomnography in a laboratory to sleep setting. CMS 'new policy will cover CPAP after a positive at-home sleep test.

In the home tests, the patient wears a device during sleep, collects and stores data on The air circulation and other measurements. The patient takes the device to the doctor, uses the data collected by the device to determine whether the patient has obstructive sleep apnea or sleep needs further study or assessment.

Some patients with OSA not continue with CPAP treatment or not to the treatment. example, CMS is limiting the initial coverage of the OSA CPAP to twelve weeks, to determine if the recipient responds to the CPAP therapy. Long-term CPAP is for the beneficiaries, and continue to respond to treatment.

"Our policy revised offers more options for Medicare beneficiaries and their treating physicians," said CMS Acting Administrator Kerry Weems. "At the same time, we will continue to be vigilant to ensure that Medicare payments for these services will not create incentives for inappropriate."

CMS will continue to monitor the use of the CPAP home test, examining the potential for fraud and abuse, and making recommendations for the implementation of appropriate protective measures to prevent possible risks.

The final determination of the national reporting announced, visit the Web site CMS here

Centers for Medicare & Medicaid Services

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