A few weeks ago I posted on the subject of new medicare requirements for the coverage of a cpap machine.
An interesting part of the new requirements appears to mandate that the physician who will be prescribing the cpap machine see the patient prior to the initial psg:
INITIAL COVERAGE:A single level continuous positive airway pressure (CPAP) device (E0601) is covered for the treatment of obstructive sleep apnea (OSA) if criteria A - C are met:
The patient has a face-to-face clinical evaluation by the treating physician prior to the sleep test to assess the patient for obstructive sleep apnea.
The patient has a Medicare-covered sleep test that meets either of the following criteria (1 or 2):
The patient and/or their caregiver has received instruction from the supplier of the CPAP device and accessories in the proper use and care of the equipment.If a claim for a CPAP (E0601) is submitted and all of the criteria above have not been met, it will be denied as not medically necessary.
Currently most of the medicare patients who come through Somnus Sleep Clinic are referred directly for a polysomnogram, I see them after the polysomnogram. If they need cpap, I will typically schedule them for the titration study and then see them back again after that to prescribe cpap. I guess I need to start seeing patients with Medicare prior to their initial psg.
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My understanding is that the examination can be carried out by the primary care doctor as "treating physician" who orders the PSG. You would become the treating physician if you assume responsibility for follow up care.
David Szabo:
thanks for the clarification
Way to put a really important treatment just a little further out of reach, Medicare. What if someone had their initial sleep study before seeing the CPAP machine prescribing doctor simply because they didn't know about this regulation, or were misinformed somewhere along the line? I sure hope they'd give them a second chance to do it in the "right" order.
It also appears that Medicare may require for a physician to be present in the room ("direct personal supervision") during the entire CPAP titration test in order to pay for the CPAP test if the test is performed in a non-hospital setting in the following states: Connecticut, Kentucky, Illinois, Indiana, Maine, Massachusetts, Michigan, New York (entire state), New Hampshire, Ohio, Vermont, Virginia, West Virginia, and Wisconsin.
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After being referred by my neurologist, I recently had a sleep study. I am concerned that I never saw the physician who read the test, no did I get my full results. I got a call from the sleep center telling me my score was 17 when 5 was normal, but did not explain what that meant. I went back had a follow study, and was prescribed a cpap machine. I never saw the doctor before or after the test. What is Medicare's requirement's for paying for the test? I read online that the provider must have a face-to-face followup with 30 to 90 days, but I am just getting calls saying that I have to send in a card from the machine to prove compliance. I asked about seeing the physician and was told that a visit would be arranged, but no one has called me about it. Does medicare require you to see the physician that reads the tests and prescribes the cpap?
how long must I have a CPAP machine before I can get a replacement machine from medicare. My current company has not returned my calls.
Although this question is not about medicare it is about CPAP Machines. Can these machines be re-calculated after a time period?? My husband was diagnosed with obstructive sleep apnea in 2004 and outfitted with a cpap machine. He did great for the first 5 years but now seems to be struggling with it. Lots of jerking and blowing of air from his mouth and what literally sounds like snoring with the mask on and the machine running. He has gained about 30 lbs since 2004 and now is once again extremely tired. Any information would be wonderful!
Does insurance company covers for CPAP machines if the doctor will prescribed you for using this machine?
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