U.S. Range PS-4-20 Spezifikationen Seite 48

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Medicare Policy for Treatment of OSA
(Effective 2/4/11)
Medicare Policy for Treatment of OSA
(Effective 2/4/2011)
CPAP Qualifi cations (E0601)
Patient must meet all the following criteria to qualify for an E0601
device (CPAP, such as S9
Series)
Patient has had a face-to-face clinical evaluation
1
by treating
physician prior to sleep test. See back for additional information.
Patient has had a Medicare-covered sleep test
2
that meets
either of the following criteria:
a. AHI/RDI
3
is ≥ 15 events per hour with minimum of 30 events;
or,
b. AHI/RDI is ≥ 5 and ≤ 14 events per hour with minimum of
10 events and documentation of excessive daytime
sleepiness, impaired cognition, mood disorders, insomnia,
hypertension, ischemic heart disease or history of stroke.
See back for additional information.
Diagnosed with OSA (ICD-9 code of 327.23)
Patient and/or caregiver has received instruction from the
supplier of the CPAP device and accessories in the proper use
and care of the equipment.
Bilevel Qualifi cations (E0470)
(Follow for CPAP to bilevel conversion)
Patient must meet all the following criteria to qualify for an E0470
device (bilevel without a backup rate, such as VPAP
Auto)
Patient is qualifi ed for E0601 (CPAP)
Treating physician documented both of the following issues
were addressed prior to changing a patient from an E0601 to an
E0470 device due to ineffective therapy:
a. An appropriate interface has been properly fi tted and the
benefi ciary is using it without dif culty. The properly fi tted
interface will be used with the E0470 device; and
b. The current pressure setting of the E0601 prevents the
benefi ciary from tolerating the therapy, and lower pressure
settings of the E0601 were tried but failed to:
1. Adequately control the symptoms of OSA; or
2. Improve sleep quality; or
3. Reduce the AHI/RDI to acceptable levels.
Ye s No
Has CPAP been used < 3 months?
(ie, CPAP is tried and found ineffective
during the initial 3-month home trial)
If “No,” a new initial face-to-face clinical evaluation is required
but not a new sleep test. A new 3-month trial would begin for
use of the bilevel. See back for additional information.
If “Yes,”the patient is qualified for an E0470 device (bilevel without a backup rate,
such as VPAP Auto). See back for additional information.
Documentation for Continued Coverage
4
(For continuing to bill months 4-13)
Between 31st and 91st day, treating physician has a face-to-face clinical re-evaluation with patient documenting that symptoms of OSA improved.
Objective evidence of adherence to use of the PAP device reviewed by treating physician. (Adherence is use of PAP ≥ 4 hours per night on 70% of nights
during a consecutive 30-day period anytime during the fi rst 3 months of initial usage. Documentation of adherence to PAP therapy shall be accomplished
through direct download or visual inspection of usage data.)
46 S9 VPAP Tx Lab System | Sleep Lab Titration Guide
ResMed.com
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