Home Sleep Testing Criteria Revised

CMS has revised its NCD for CPAP therapy.

The policy now states: “An initial 12-week period of CPAP is
covered for adult patients with OSA if the patient meets either of
the following criterion using the AHI (Apnea-Hypopnea Index) or RDI
(Respiratory Disturbance Index) are met: a) AHI or RDI greater than
or equal to 15 events per hour; or b) AHI or RDI greater than or
equal to 5 events, and less than or equal to 14 events per hour
with documented symptoms of excessive daytime sleepiness, impaired
cognition, mood disorders or insomnia, or documented hypertension,
ischemic heart disease or history of stroke. The AHI or RDI is
calculated on the average number of events per hour. If the AHI or
RDI is calculated based on less than two hours of continuous
recorded sleep, the total number of recorded events to calculate
the AHI or RDI during sleep testing must be at a minimum the number
of events that would have been required in a two-hour period.”

View the
revised NCD.