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Final CPAP coverage decision

This article was originally published in The Gray Sheet

Executive Summary

CMS relaxes its standards for covering continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea under a March 13 final coverage 1decision. The determination, largely in-line with a Dec. 14 CMS proposal, expands CPAP reimbursement to include situations in which sleep apnea is diagnosed with the combination of a clinical evaluation and a home monitoring device (Type II, III or IV) (2"The Gray Sheet" Jan. 7, 2008, p. 15). For other types of monitoring devices, CMS outlines coverage-with-evidence-development requirements. Medicare previously paid for OSA treatment only if diagnosed by a clinical assessment and confirmed by polysomnography in a sleep laboratory. The final decision also removes the need for two hours of continuous recorded sleep for diagnosis if a minimum number of apnea-associated events are identified in a shorter time period, and no longer requires that patients have "moderate to severe" OSA for CPAP reimbursement, where surgery is the likely alternative. CPAP device makers include ResMed, Philips/Respironics and Itamar Medical

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