Understanding Medicare Coverage for Positive Airway Pressure Devices

Noridian's dedicated resource page for Positive Airway Pressure (PAP) Devices provides essential guidance for suppliers navigating Medicare coverage for the treatment of Obstructive Sleep Apnea (OSA).

Coverage Overview

Medicare covers PAP therapy-including CPAP and BiPAP devices-when specific clinical criteria are met. These include a documented diagnosis of OSA through a qualifying sleep study and evidence of medical necessity. The National Coverage Determination (NCD 240.4) outlines these requirements in detail.

Documentation Requirements

To ensure compliance, Noridian offers:

  • Clinician Checklists for initial and continued coverage
  • Clinician Letters to assist in documenting medical necessity and continued use
  • Guidance on Sleep Study Standards and acceptable testing methods

Adherence and Compliance

Medicare requires patients to demonstrate adherence within the first 90 days of therapy. Devices must track usage accurately, and suppliers are encouraged to educate patients on the importance of consistent use to avoid loss of coverage.

Supplier and Clinician Support

The site includes:

  • Medical Review Tips
  • Audit Findings
  • Tips and articles to help streamline the claims process
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