CMS CPAP Coverage Timeline
1986
• After conducting a study, the Office of Health Technology Assessment (OHTA) recommended that Medicare should cover CPAPs when used in adult patients with severe to moderate OSA who couldn’t obtain relief from other non-invasive therapies.
1989
• Medicare adopted OHTA’s recommendations on the diagnosis of OSA and issued a NCD that covered CPAP for adult patients with moderate or severe OSA.
• CMS reviews unattended Home Sleep Study.
1995
• CMS’s reviewing body for the development of NCD’s concluded that the safety and effectiveness of home studies used to diagnose sleep disorders were unproven and should not be covered by Medicare.
• The committee recommended that the issue be revisited for national policy following the completion of a study of sleep disorders conducted by the National Institute of Health. The study was expected to be complete in two to three years. The coverage of unattended HST was left to the discretion of the carrier.
2001
• The national coverage policy on CPAP was expanded to include Medicare beneficiaries with an apnea-hypopnea index > 15, or an AHI > 5 and < 14 with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia or documented hypertension, ischemic heart disease or history of stroke.
• The policy specified that only PSG done in a facility-based sleep study lab could be used to identify patients with OSA.
2005
• CMS determined that evidence was not adequate to conclude that the use of unattended portable multi-channel sleep testing with a minimum of 7 monitored channels including EEG, EOG, EMG, ECG or heart rate, airflow, respiratory effort and oxygen saturation was reasonable and necessary in the diagnosis of OSA and the test remained uncovered.
2007
• CMS receives a request to reconsider the 2005 NCD for CPAP Therapy for OSA to allow coverage of CPAP based upon a diagnosis of OSA by home sleep testing.
2008
• CMS released its final rule on home sleep testing that expanded coverage for home sleep testing devices II, III, and IV for the diagnosis of obstructive sleep apnea.
Source: Centers for Medicare and Medicaid Services
This article originally appeared in the May 2008 issue of HME Business.