Covered by Medicare if the patient is diagnosed with obstructive sleep apnea (OSA). This diagnosis must be documented by an attended, facility-based polysomnogram (sleep study).

In addition to the polysomnogram, the patient must meet either of the following criteria (1 or 2):

1) The AHI (apnea-hypopnea index) is ≥ 15 events per hour
OR
2) The AHI is from 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.

The AHI must be calculated based on a minimum of 2 hours of recorded sleep and must be calculated using actual recorded hours of sleep (i.e. the AHI may not be an extrapolated or projected calculation). Continued coverage of a CPAP beyond the first three months of therapy requires that no sooner than the 61st day after initiating therapy, we ascertain from either the beneficiary or the treating physician that the beneficiary is continuing to use the CPAP device.

Supplies will be reimbursed separately.

CPAP/BiPAP S Accessories:

Covered with a medically necessary CPAP or BiPAP S. Must be listed separately on the CMN or prescription.

Accessories in excess of these time frames are rarely considered medically necessary.