U.S. Range PS-4-20 Spezifikationen PDF herunterladen (Seite 49)

Document criteria for

ineffective CPAP therapy

Document criteria for

ineffective CPAP therapy

Document criteria for

ineffective CPAP therapy

Rx for E0470Rx for E0470Rx for E0470

New face-to-face clinical evaluation

Clinical re-evaluation and

documentation of adherence on

the bilevel between 31

– 91

day

from bilevel initiation

Clinical re-evaluation and

documentation of adherence

on the bilevel by 120

day

from CPAP initiation

Clinical re-evaluation and

documentation of adherence on

the bilevel between 31

– 91

day from CPAP initiation

Bilevel Conversion Pathways

1 Face-to-face clinical evaluation may include sleep history and symptoms of OSA,

Epworth Sleepiness Scale and physical exam documenting body mass index, neck

circumference and a focused cardiopulmonary and upper airway evaluation. Some of

these elements, in addition to other details, must be documented in patient charts.

2 Medicare-covered sleep tests include Type I, Type II, Type III and Type IV (must monitor

and record a minimum of three (3) channels). All sleep tests must be interpreted by a physi-

cian who is board-certiﬁ ed in sleep medicine by the ABSM, board-certiﬁ ed in sleep medicine

by member board of ABMS, trained in an ABMS member board specialty and is awaiting

exam, or active staff member of an AASM or The Joint Commission accredited sleep center

or lab. (Effective 11/1/08 for Home Sleep Testing and 1/1/10 for Polysomnography)

3 AHI is deﬁ ned as the average number of episodes of apnea and hypopnea per hour of sleep.

RDI is deﬁ ned as the average number of apneas plus hypopneas per hour of recording.

4 If the patient fails the 12-week trial:

Beneﬁ ciaries requalify for a PAP device with both:

1. Face-to-face clinical re-evaluation by treating physician to determine etiology of failure to

respond to PAP therapy; and

2. Repeat sleep test in a facility-based setting (Type 1 study).

Post Day 90

(from initial CPAP setup)

Day 61 – 90

(from initial CPAP setup)

Day 1 – 60

(from initial CPAP setup)

Interpreted from: Centers for Medicare & Medicaid Services, “LCD for Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea” Jurisdiction A

(L11528): http://www.cms.hhs.gov/mcd/. Please note it is the provider’s responsibility to verify current requirements and policies with local payors before ﬁ ling any claims.

Lab Support 24/ 7 (888) 288-6738 | Sleep Lab Titration Guide 47

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