Effective for services on April 1, 2002
Initial coverage for the use of CPAP devices are covered under Medicare
when ordered and prescribed by the licensed treating physician to be used in
adult patients with OSA if either of the following criteria using the Apnea-Hypopnea
Index (AHI) are met:
- AHI > 15 events per hour, or
- AHI > and < 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 must be calculated based on a minimum of two hours of sleep
recorded by polysomnography using actual recorded hours of sleep (i.e.,
the AHI may not be extrapolated or projected).
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