CMS Announces Revision to NCD 240.4 CPAP Therapy for OSA

The Centers for Medicare & Medicaid Services (CMS) has revised the language in its National Coverage Determination (NCD) for Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA) (240.4). The NCD Decision Memo was issued on March 13, 2008, and the implementation date was August 4, 2008. Following is a list of some key points in the revised policy: 

  • Coverage of CPAP is initially limited to a 12-week period for beneficiaries diagnosed with OSA. CPAP is subsequently covered for those beneficiaries diagnosed with OSA whose OSA improves as a result of CPAP during this 12-week period.
  • CPAP for adults is covered when diagnosed using a clinical evaluation and a positive: Polysomnography (PSG) performed in a sleep laboratory; or Unattended home sleep monitoring device of Type II; or
  • Unattended home sleep monitoring device of Type III; or
  • Unattended home sleep monitoring device of Type IV, measuring at least 3 channels

A positive test for OSA is established if either of the following criteria using the Apnea-Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) is met:

  • AHI or RDI greater than or equal to 15 events per hour of sleep or continuous monitoring, or
  • AHI or RDI greater than or equal to 5 and less than or equal to 14 events per hour of sleep or continuous monitoring with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke.

View the full policy on the CMS Web site by clicking here.

2008-10-24T00:00:00+00:00 October 24th, 2008|Professional Development|