Continuous Positive Airway Pressure CIM Revision

Original Effective Date: 03/15/2002
Revision Effective Date: 11/01/2013

Coverage Issues Manual (CIM), Section 60-17, Continuous Positive Airway Pressure (CPAP), is revised to expand Medicare coverage for CPAP in the use of obstructive sleep apnea (OSA) and to require Medicare contractors to develop a method for monitoring compliance for CPAP devices.

This revision to the CIM is a National Coverage Decision (NCD). NCDs are binding on all Medicare Carriers, Intermediaries, Peer Review Organizations, Health Maintenance Organizations, Competitive Medical Plans, and Health Care Prepayment Plans. Under 42 CFR 422.256 (b), an NCD that expands coverage is also binding on a Medicare +Choice Organization. In addition, an administrative law judge may not review an NCD. (See §1869 (f)(1)(A)(I) of the Social Security Act.)

This policy revision is effective for services provided on or after April 1, 2002. See Chapter 10 of the DMERC Region D Supplier Manual for the complete text of this national policy. Also, refer to the revised Continuous Positive Airway Pressure System LMRP included in the accompanying supplier manual update.

Last Updated May 05 , 2017