Medicare Rules on CPAP Compliance

CPAP Compliance refers to the measurement of how long or how much a patient uses the CPAP machine on a nightly basis and whether the machine is effective. A patient who is compliant is one who uses his CPAP machine for four hours or more per night for a period exceeding 70 percent of all nights. There are various reasons for poor CPAP compliance. They include patients experiencing side effects of CPAP treatment such as dry or sore nose and throats.

Rules on Obstructive Sleep Apnea

• Sleep apnea is the temporary cessation of breathing. Initially, CPAP treatment normally covered only adult patients with the obstructive form of sleep apnea (OSA). You can be diagnosed with OSA if you experience at least 30 episodes of sleep apnea. Each episode should last at least 10 seconds within six to seven hours of sleep. A doctor can make this diagnosis after you undergo polysomnography while sleeping in a laboratory setting.

Rules on Documentation

• Medicare has documentation requirements for patients who use CPAP. There must be visual inspection of usage data and filling of a written report about the patient, which his physician reviews. The patient should also provide his medical records to the physician upon request.

Rules on Change From CPAP to BiPAP

• These rules apply to those patients who are changing from CPAP to BiPAP treatment. The physician responsible for the patient's treatment should lower pressure settings that cause the CPAP to fail so as to control the CPAP's side effects. A doctor should re-evaluate the patient within the first three months of treatment.