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Your Health . . . Our Concern . . . At Home Serving Connecticut for over 25 years Toll Free Phone: 1.888.575.7778 Toll Free Fax: 1.800.221.3003 |
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Your Health . . . Our Concern . . . At Home Serving Connecticut for over 25 years Toll Free Phone: 1.888.575.7778 Toll Free Fax: 1.800.221.3003 |
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* To initiate
therapy patient must have the following: a "face to face"
evaluation with their treating physician and the evaluation should
include: signs and symptoms of OSA (sleep history), Epworth
Sleepiness Scale, BMI, neck circumference and evaluation of cardiopulmonary
and upper airway system. * Documentation of face to face evaluation needs to be contained in patient's chart notes and forwarded to DME company with referral. * After patient is set up on PAP equipment, patient must have a "re evaluation" with the treating physician no sooner than the 31st day but no later than the 90th day on service. * Re evaluation" needs to include the following: documentation that the symptoms of OSA have improved and objective evidence of compliance to therapy (ie: download) which must be reviewed by the treating physician. * Compliance is defined by Medicare for this policy as use of PAP device for at least 4 hours per night for 70% of the nights in a 30 consecutive day period during the first 90 days. * If above criterion is not met, Medicare will not consider the PAP device "medically necessary" and will not cover the cost of the device. * If patient does not meet criteria for coverage within the 90 day period, then in order for patient to "re-qualify" for PAP therapy, the patient must undergo another "face-to-face" clinical evaluation with the treating physician and attend another "facility-based" sleep test to assist in discerning the reasons for the initial failure. * ICD-9 code 327.23 is now the only acceptable code for PAP devices for patients diagnosed with "obstructive sleep apnea." * RDI…for purposes of this policy, RDI only includes apneas and hypopneas (RERA's have not yet been defined and according to this new ruling may not be included in the extrapolation of the RDI.) |
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