Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea - Policy Article
A52467
PAP devices are covered under the DME benefit when Medicare eligibility and the reasonable-and-necessary requirements in the related LCD are met; accessories are reimbursable at initial issue and when medically necessary replacements are required. Final Rule 1713 requires a face-to-face encounter and a Written Order Prior to Delivery (WOPD) for specified HCPCS codes and claims without these will be denied; documentation requirements include a focused initial evaluation (history, Epworth score, exam with neck circumference and BMI) and a re-evaluation between day 31 and day 91 documenting symptom improvement and objective adherence. Liners (A9270) are noncovered for additional payment and claims for A9279 are statutorily denied; suppliers may not perform home sleep test delivery or pickup.
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