Noninvasive Positive Pressure Ventilation

Aetna covers NPPV as DME using bilevel PAP for restrictive thoracic disorders (progressive neuromuscular disease or severe thoracic cage abnormality), severe COPD, central or complex sleep apnea, hypoventilation syndrome, and OSA only with bilevel PAP without a backup rate; NPPV/ventilators for other indications, bilevel PAP with backup for primary OSA, single‑breath nitrogen testing, and exsufflation belts are excluded or considered experimental/investigational. Coverage requires specific physiologic criteria (eg, awake PaCO2 ≥45 mm Hg for restrictive disorders or ≥52 mm Hg for severe COPD; nocturnal SpO2 ≤88% for ≥5 cumulative minutes with a minimum 2‑hour recording; for neuromuscular disease MIP <60 cm H2O or FVC <50% predicted), CPAP must be considered/ruled out for OSA, and adding a backup rate is permitted only with documented PaCO2 worsening ≥7 mm Hg plus PSG desaturation without obstructive events or after ≥60 days of compliant (≥4 hr/day) bilevel use if hypercapnia/desaturation persist.