As a Medicare beneficiary you can receive a CPAP machine if you meet all of the following requirements:

  1. Evidence of a face to face evaluation by your treating physician documented in your chart.
  2. Your physician must request a sleep test.
  3. Your diagnosis must be obstructive sleep apnea.

    Test results must show;
    Your AHI or RDI is greater than or equal to 15 events per hour with a minimum of 30 events OR  Your AHI or RDI is greater than or equal to 5 and less than 14 per hour with a minimum 10 events and documentation of:
  4. Excessive daytime sleepiness, impaired cognition, mood disorders, insomnia OR Hypertension, ischemic heart disease or history of stroke.
  5. The written orders must include:
  • Beneficiary’s name
  • Date of order
  • Detailed description of items being ordered such as device with or without humidity, type of mask, headgear, filters and tubing.
  • Pressure settings
  • Frequency of use or duration
  • Treating practitioner’s printed name and NPI
  • Treating practitioner’s signature and date

Coverage beyond the first three months:

Between 31 and 91 days of therapy the patient is required to meet with their ordering physician for a re-evaluation face to face to document the improved benefits from using the therapy. Secondly the patient must maintain a minimum acceptable usage of 4 hours per night on 70% of the nights during the first 30 day trial period.

If patient does not meet the minimum requirements at this point, the device must be returned to the provider or a re-qualifying for the device must take place.