New Medicare PAP Regulations

Medicare now requires a face-to-face sleep evaluation prior to a patient’s sleep study in order to provide CPAP or Bi-Level PAP treatment for obstructive sleep apnea.

Continued coverage of a PAP device beyond the first three months of therapy requires a face-to-face clinical re-evaluation during the second two months after initiating therapy.

Sleep HealthCenters will send Medicare Compliance Forms for all Medicare patients requiring a sleep study and/or PAP therapy for your approval.

On the compliance form, you can choose to have Sleep HealthCenters manage compliance and Medicare paperwork by having your patient evaluated by Sleep HealthCenters prior to the sleep study; OR, you can choose to manage the patient yourself by providing required information to Sleep HealthCenters along with your sleep study referral.

Compliance forms must be completed or the PAP device and related accessories will be considered not medically necessary and coverage will be denied by Medicare.

If you have questions about these new regulations, please contact us at 877-753-3742.

To view full requirements and compliance forms, choose from below:

• Pre-Sleep Study Requirements and Compliance Form
• Post-PAP Set Up Requirements and Compliance Form
• LCD for Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L11528)