Move over CPAP, there's a new therapy in town

Tuesday, December 21, 2010

BALTIMORE - Medicare's decision in November to pay for oral appliances to treat sleep apnea barely registered a blip on CPAP providers' radar.

"Is anybody even going to be interested in doing this?" said provider Todd Cressler, president of CressCare Medical in Harrisburg, Pa.

For claims on or after Jan. 3, 2011, custom oral appliances used to treat sleep apnea (E0486) would be covered if certain criteria are met. Those criteria include a face-to-face evaluation with the treating physician; an inability to tolerate a PAP device; and provision and billing by a dentist.

Very few dentists bill Medicare, said Cressler.

"I guess we'll see what benefits dentists would have in dispensing it," he said.

Oral appliances have been demonstrated to be effective for patients with mild sleep apnea, say providers.

"We see a few patients every now and then who go from CPAP to the devices," said Erick Parkhill, vice president of Atlanta, Ga.-based Home Medical Professionals. "Some try it and go back to the CPAP."

In the long run, what's most important is the continued recognition by CMS that obstructive sleep apnea is a serious and pervasive condition, said Ed Grandi, executive director of the American Sleep Apnea Association.

"CPAP is perhaps too much therapy for some patients," he said. "CMS has recognized that there are alternate therapies beyond CPAP." hme