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.