(10-04-2015, 07:37 PM)Mike1953 Wrote:(10-04-2015, 04:22 PM)DariaVader Wrote: not sure what your point is. that is still the coverage for cpap rather than asv.
It is the same. https://www.cms.gov/Outreach-and-Educat ... 905064.pdf
Bilevel machines which have the "Backup Rate" feature (like ASV and ST therapy modes) have a different reimbursement code and have additional requirements for coverage.
I don't remember the precise requirements, but (from memory) the USA Medicare requirements for coverage of a machine with a backup respiration rate for treating central events are approximately as listed below:
1. The doctor must obtain preauthorization for a special ASV or ST titration. Obtaining preauthorization will require documentation that central apnea events are occurring at a rate of at least 5 per hour when the patient is using standard 'PAP therapy to treat obstructive events, and the central events are the dominant remaining problem. That is, when treated by standard 'PAP machine central events outnumber obstructive events, and the CAI is, all by itself, at least 5.
2. The ASV or ST titration must identify pressure settings at which the ASV therapy or ST therapy adequately prevents/treats the problem.
If any of the requirements are not met then I think Medicare will not cover any of the costs for the machine and supplies until all requirements are met.
If one has financial resources to purchase machine and supplies out of pocket, then only the doctor's prescription is needed.