Continuous Positive Airway Pressure

Sleep apnea is a disorder that causes people to frequently stop breathing for short periods while sleeping. As a result, they fail to get:

  • A restful night's sleep
  • The oxygen their body needs

If left untreated, sleep apnea increases the risk of high blood pressure, heart problems, and stroke. CPAP (Continuous Positive Airway Pressure) is utilized for the treatment of obstructive sleep apnea. Your doctor has prescribed a CPAP System for your use at home for the treatment of obstructive sleep apnea.

The equipment delivers a flow of air at a prescribed amount of pressure, applied through a mask over the nose. This pressure prevents the structures in your throat from blocking air movement in and out of your lungs while you sleep. You will experience almost immediate relief from your symptoms by using CPAP Therapy.

Medicare Information and Qualifications:

Medicare covers a single level CPAP device, for initial coverage, if the patient, during sleep, temporarily stops breathing, called obstructive sleep apnea. Medicare requires an overnight sleep study performed in a sleep laboratory (the study is called a polysomnography or PSG). What that study has to show is either of the following criteria using the Apnea Hypopnea Index (AHI) is met:

  • The AHI is > 15 events per hour OR
  • The AHI is > 5 to 14 events per hour with documented symptoms of:
  • Excessive daytime sleepiness, impaired cognition, mood disorders, or insomnia or
  • Hypertension, ischemic heart disease, or history of stroke.

Medicare covers the use of the CPAP for up to 3 months. If a patient requires the CPAP beyond 3 months, no sooner than the 61st day after beginning use of the CPAP, the supplier must be notified by the doctor or the patient that there will be continued use beyond the three-month period. Medicare covers accessories used with the CPAP if the CPAP is covered by Medicare: masks; cannulas; tubing and other necessary supplies.

An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor.

CPAPs are in the Capped Rental category of DME; that means you may choose to rent or purchase a CPAP.

After three months of use, you will be required to verify if you are benefiting from using the device and how many hours a day you are using the machine.

The items listed below are often sold, prescribed or needed in addition to the equipment above.

  • Replacement masks or cannulas
  • Supply tubing
  • Filters
  • Head Gear
  • Humidifier chambers
  • Seals or cushions/pillows

Disclaimer: This is a sampling of information. Please refer to the CMS website (www.cms.gov) and consult your own experts for additional information.