CMS reviews CPAP coverage criteria

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Sunday, March 18, 2007

WASHINGTON - CMS began a review last week of its coverage criteria for CPAP therapy, including whether it should allow home-based sleep studies. Current national coverage policy specifies that only polysomnography done in a facility-based sleep lab can be used to identify patients with OSA who require CPAP.

CMS initiated the review after the American Academy of Otolaryngology-Head and Neck Surgery requested that Medicare allow portable multi-channel home sleep testing devices as an alternative to facility-based polysomnography.

In addition, CMS has received a request from a Medicare beneficiary, numerous informal requests from stakeholders and interest from Medicare contractors concerning the criteria for determining the apnea-hypopnea index (AHI).

The current NCD states in part that ".the AHI is equal to the average number of episodes of apnea and hypopnea per hour and must be based on a minimum of 2 hours of sleep recorded by polysomnography using actual recorded hours of sleep (i.e. the AHI may not be extrapolated or projected)."

Stakeholders want this changed, too: "the AHI is equal to the average number of episodes of apnea and hypopnea per hour and must be based on a minimum of 2 hours of sleep or less, if the actual number of AHI episodes recorded is 30 or more in less than 2 hours, recorded by polysomnography using actual recorded hours of sleep (i.e., the AHI may not be extrapolated or projected)."

CMS also stated that it was "aware of recently published research suggesting a benefit for the use of CPAP without prior sleep testing in selected populations."

CMS will accept public comment on these proposals for 30 days (starting March 14). The agency stated that it "considers all public comments and is particularly interested in clinical studies and other scientific information relevant to the technology under review."

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