CMS publishes further guidance on CPAP accessories

Thursday, September 1, 2016

WASHINGTON – CMS recently published change request 9741, providing further guidance to the DME MACs on medical reviews of claims for replacement accessories for beneficiary-owned CPAP and RAD devices. CMS has clarified that medical necessity is assumed to be established when Medicare initially pays for the base DME item. This guidance only applies to base items that were paid by Medicare for the entire 13 months. For replacement accessories claims, contractors will only review the continued medical need requirement for the base item, and the medical necessity of the accessory replacement (or furnishing of new accessories) and whether it is essential in using the base item.