Prescription - CPAP - APAP - BIPAP

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General Information

CPAP choice to treat OSA, CA, obstructive or pulmonary restriction

The Auto CPAP such as the AirSense 10 AutoSet is typically the initial machine of choice for treatment of obstructive apnea and hypopnea

Just to clarify The VAUTO, ASV and the ST are all BiLevel machines for treating three different conditions, they are NOT interchangeable. They are not a choice between the three to treat a single condition.

They should be chosen to treat the specific condition that the user has,

  • To treat obstructive apnea and minor hypopnea and for most initial treatments a standard Auto CPAP such as AirSense AutoSet (or for her) is appropriate.
  • To treat obstructive apnea and hypopnea, and a standard Auto CPAP is insufficient the treatment of choice is the Aircurve 10 Vauto (has higher pressure and greater Pressure Support (PS) (similar to EPR) available
  • To treat central apnea, the only appropriate therapy would be the Aircurve 10 ASV
  • To treat obstructive or pulmonary restriction including hypoventilation, would be the Aircurve 10 ST
(best choice) indicates a full data capable machine that has Sleepyhead software capability and an Auto Mode.  These are in general the best available machines

Always specify the exact machine you wish, This removes all ambiguities and prevents substitutions.

DAW (Dispense as Written) prevents substitutions.

General Information on DreamStation Models from Philips Respironics

Current acceptable in Production Machines (ResMed and Philips Respironics, the 2 most popular manufactures)

  • ResMed AirSense 10 AutoSet (best choice) (E0601) (Fixed CPAP, Auto CPAP)
  • ResMed AirSense 10 AutoSet for Her (best choice) (E0601) (Fixed CPAP, Auto CPAP)
  • ResMed AirSense™ 10 Elite CPAP Machine with HumidAir™ Heated Humidifier (37205) (E0601) (Fixed CPAP)
  • ResMed AirCurve 10, all models
  • ResMed AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier (37211) (E0601, E0562) (best choice) (Fixed CPAP, BiLevel S, VAuto (Auto-BiLevel))
  • ResMed AirCurve™ 10 ASV BiLevel Machine w/HumidAir™ Humidifier (E0471) (best choice) (Fixed CPAP, ASV, ASV Auto)
  • Philips Respironics DreamStation Auto CPAP Machine (DSX500x11) (Not all DreamStation Models, Check SN on bottom, bricks look the same) (Fixed CPAP, Auto CPAP) (best choice)
  • Philips Respironics DreamStation CPAP Pro (DSX400x11) (Not all DreamStation Models, Check SN on bottom) (Fixed CPAP)
  • Philips Respironics DreamStation BiPAP Pro (DSX600x11) (Not all DreamStation Models, Check SN on bottom) (Fixed CPAP, Fixed BiPAP)
  • Philips Respironics DreamStation BiPAP Auto Machine (DSX700x11) (Not all DreamStation Models, Check SN on bottom) (Fixed CPAP, Fixed BiPAP, Auto BiPAP) (best choice)

Current Machines to Avoid

  • Any ResMed AirStart (Lack of full data capability)
  • ResMed AirStart™ 10 CPAP Machine with HumidAir™ Heated Humidifier (all models, 37201) (Lack of full data capability)
  • ResMed AirSense™ 10 CPAP Machine with HumidAir™ (37015, 37203) (Lack of full data capability)
  • Philips Respironics DreamStation CPAP (DSX200x11) (Not all DreamStation Models, Check SN on bottom) (Lack of full data capability)

Note: These are current machines, there are older models that have full data capability that are available via secondary markets if budget is an issue. Please inquire on the forum and your questions will be answered.



Difference in Full Data Capability

We get a lot of questions about the difference so below are examples of a fully data capable machine vs a "Brick" or non-data-capable machine.

These examples are from an Auto Machine


A non full data Capable machine looks like

The detailed data is simply just not there.

CPAP Machine Descriptions

(best choice) indicates a full data capable machine that has Sleepyhead software capability and an Auto Mode.  These are in general the best available machines

ResMed CPAP

  • ResMed AirStart line (Avoid this product line)
    • ResMed AirStart™ 10 CPAP Machine with HumidAir™ Heated Humidifier (all models) (Lack of full data capability) We do not recommend this machine because of its (Lack of full data capability)
      • Model List - 3 May 2017 - AirStart™ 10 CPAP: 37002, 37201, We do not recommend these models
      • Model List - 3 May 2017 - AirStart™ 10 APAP: 37008, 37202, We do not recommend these models
  • The AirSense™ 10 line includes:
    • AirSense™ 10 CPAP: The ResMed AirSense 10 CPAP is a basic fixed-pressure device with integrated humidifier and cellular connectivity. We do not recommend this machine because of its (Lack of full data capability)
      • 37203 CPAP model, standard tube, no data. fixed pressure, We do not recommend this machine, Current US model 3 May 2017
      • 37204 CPAP model, heated tube, no data, fixed pressure, We do not recommend this machine, Current US model 3 May 2017
      • Model List - 3 May 2017: 37014, 37015, 37016, 37017, 37018, 37063, 37072, 37203, 37204, 37217, 37218, 37285, 37311, 37312, 37325, 37395, 37398, 37399, 37440, We do not recommend these models
    • AirSense™ 10 Elite: The ResMed AirSense 10 Elite is a premium fixed-pressure device with integrated humidifier, cellular connectivity and advanced event detection.
      • 37205 CPAP Elite Model, standard tube, data, fixed pressure, Current US model 3 May 2017
      • 37206 CPAP Elite Model, heated tube, data fixed pressure, Current US model 3 May 2017
      • Model List - 3 May 2017: 37019, 37020, 37021, 37022, 37023, 37024, 37025, 37043, 37071, 37205, 37206, 37219, 37220, 37234, 37235, 37243, 37244, 37256, 37265, 37270, 37286, 37313, 37314, 37326, 37338, 37355, 37366, 37371, 37393, 37400, 37401, 37424, 37439
    • AirSense™ 10 AutoSet™: The ResMed AirSense 10 AutoSet is a premium auto-adjusting pressure device with integrated humidifier, cellular connectivity and advanced event detection. (best choice)
      • 37207 Autoset, standard tube, data, auto pressure, Current US model 3 May 2017
      • 37208 Autoset, Climateline tube, data, auto pressure, Current US model 3 May 2017
      • Model List - 3 May 2017: 37027, 37028, 37029, 37030, 37031, 37032, 37033, 37064, 37065, 37067, 37207, 37208, 37221, 37222, 37236, 37237, 37245, 37246, 37254, 37258, 37259, 37266, 37271, 37273, 37274, 37287, 37294, 37315, 37316, 37319, 37321, 37327, 37339, 37352, 37367, 37372, 37402, 37403, 37436
    • AirSense™ 10 AutoSet™ for Her: The ResMed AirSense 10 AutoSet for Her is a premium auto-adjusting pressure device for female patients. It also includes an integrated humidifier, cellular connectivity and advanced event detection. (best choice)
      • 37209 Autoset For Her, Climateline tube, data, auto pressure, for her algorithm., Current US model 3 May 2017
      • Model List - 3 May 2017: 37034, 37035, 37036, 37037, 37039, 37040, 37041, 37066, 37209, 37210, 37223, 37224, 37247, 37260, 37288, 37295, 37317, 37318, 37320, 37322, 37328, 37353, 37368, 37390, 37396, 37404, 37405, 37420, 37421, 37422, 37423, 37437

ResMed BiPAP/BiLevel

  • The AirCurve 10 line includes: (best choice)
    • AirCurve 10 VAuto: An auto-adjusting bilevel device for patients who need greater pressure support to treat their obstructive sleep apnea. It uses the comfort of both the proven AutoSet algorithm and Easy-Breathe waveform in its VAuto algorithm.
      • Model List - 3 May 2017: 37050, 37051, 37052, 37053, 37054, 37055, 37059, 37211, 37212, 37225, 37226, 37238, 37239, 37248, 37249, 37261, 37262, 37267, 37272, 37289, 37391, 37392, 37406, 37407
    • AirCurve 10 S: A bilevel device ideal for patients who need extra pressure support or find it difficult to adjust to therapy on a fixed pressure continuous positive airway pressure device. It features two different adjustable pressures that can help make therapy feel more comfortable.
      • Model List - 3 May 2017: 37045, 37046, 37047, 37048, 37068, 37213, 37214, 37227, 37228, 37250, 37251, 37290, 37340, 37351, 37397, 37408, 37409
    • AirCurve 10 ST: A bilevel device with backup rate that provides exceptional patient-ventilator synchrony, reducing the work of breathing so patients remain comfortable and well ventilated.
      • Model List - 3 May 2017: 37056, 37057, 37058, 37073, 37306, 37307, 37348, 37349, 37373, 37374, 37375, 37412, 37413
    • AirCurve™ 10 ST-A: A highly effective ventilator that also allows you to proactively monitor and follow up with respiratory insufficiency patients.
      • Model List - 3 May 2017: 28210, 28211, 28219, 28323, 28326
    • AirCurve 10 ASV: A bilevel device for central breathing disorders such as Cheyne-Stokes respiration, central sleep apnea, or obstructive events. The AirCurve 10 ASV targets the patient’s own recent minute ventilation. By treating central breathing disorders with auto-adjusting pressure support, and upper airway obstruction with auto-adjusting expiratory positive airway pressure, the device works to rapidly stabilize breathing.
      • Model List - 3 May 2017: 37042, 37043, 37044, 37215, 37216, 37229, 37230, 37291, 37410, 37411
  • Features include:
    • TiControl: Found in AirCurve 10 S, AirCurve 10 VAuto, and AirCurve 10 ST, TiControl lets providers set minimum and maximum time limits on either side of the patient’s ideal spontaneous flow cycling, creating a window of opportunity for the patient to spontaneously cycle the breath and timely intervention during challenging conditions.
    • Trigger Sensitivity: Adjustable trigger and cycle sensitivity settings TiControl, found in AirCurve 10 S, AirCurve 10 VAuto, and AirCurve 10 ST, can be used to optimize synchrony between the device and the patient’s own respiratory efforts.
    • Vsync: Advanced leak management technology, Vsync helps provide patient-ventilator synchrony. Vsync is available in all AirCurve 10 devices.
    • HumidAir: Integrated heated humidification that affords simpler therapy, with fewer parts to set up and manage.

Philips Respironics CPAP Machines

  • Philips Respironics DreamStation CPAP (DSX200x11) (Not all DreamStation Models, Check SN on bottom) (Lack of full data capability) Avoid this model
  • Philips Respironics DreamStation CPAP Pro (DSX400x11) (Not all DreamStation Models, Check SN on bottom) (Fixed CPAP)
  • Philips Respironics DreamStation Auto CPAP Machine (DSX500x11) (E0601) (S11 is Machine only, H11 is Heated Humidifier (best choice), T11 is Heated Humidifier and Heated Tube (best choice))

Philips Respironics BiPAP/BiLevel Machines

  • Philips Respironics DreamStation BiPAP Pro (DSX600x11) (Not all DreamStation Models, Check SN on bottom) (Fixed CPAP, Fixed BiPAP)
  • Philips Respironics DreamStation BiPAP Auto Machine (DSX700x11) (Not all DreamStation Models, Check SN on bottom) (Fixed CPAP, Fixed BiPAP, Auto BiPAP) (best choice)

Non-invasive ventilation (NIV) devices

  • iVAPS (intelligent Volume-Assured Pressure Support)
    • ResMed Lumis™ 150 VPAP ST: A non-invasive ventilator designed for non-dependent patients with obstructive or restrictive respiratory conditions.
      • Featuring ResMed’s unique volume-assurance mode – iVAPS (intelligent Volume-Assured Pressure Support) – Lumis 150 VPAP ST maintains target alveolar ventilation to suit each patient’s changing needs. And with an intelligent Backup Rate (iBR) and optional AutoEPAP, iVAPS continuously monitors ventilation and the upper airway. The ventilator is easy to set up and use, and features built-in wireless connectivity to AirView™ – ResMed’s cloud-based patient management system – for remote monitoring.
    • ResMed Lumis 150 VPAP ST-A: An auto non-invasive ventilator with alarms. It is designed for non-dependent patients with respiratory insufficiency.
      • The ventilator features IntelligentAir, a collection of ResMed technologies that can tailor therapy to the patient’s individual breathing needs. IntelligentAir comprises iVAPS (intelligent Volume-Assured Pressure Support), a mode that automatically adapts to the patient’s changing needs, an intelligent Backup Rate (iBR) that maximises their opportunity to breathe spontaneously, and an optional AutoEPAP to maintain upper airway patency. Lumis 150 VPAP ST-A is easy to set up and use, and features built-in wireless connectivity to AirView™ – ResMed’s cloud-based patient management system – for remote monitoring.
    • Philips BiPAP AVAPS Ventilator: A Non-Invasive ventilator that provides the comfort of pressure ventilation and the consistent efficacy of assured tidal volume
      • avaPs is a support function that can be activated within our s, s/T, PC and T pressure modes. It automatically adapts pressure support to patient needs to guarantee an average tidal volume. Inspiratory pressure increases or decreases from breath to breath to ensure the preset tidal volume. Designed especially for patients with certain diseases or disorders, such as: neuromuscular and COPD patients who have respiratory insufficiency, or obese patients with hypoventilation problems.

Prescription Template

Rx

DAW (Dispense as Written) (forces the DME to supply exactly what is specified.

Diagnosis: (choose 1)

  • Obstructive Sleep Apnea, Adult Pediatric g47.33
  • Other unspecified sleep apnea, 780.57
  • Hypersomnia with sleep apnea, unspecified 780.53

Estimated Lehgth of Service ___ Lifetime or 99 Months (The longer the better)


Machine Type (choose 1) [[1]]

  • CPAP or APAP E0601 (Do Not Use) (If you order by number (E0601) or the generic description of CPAP you will very likely get a non-auto, non-data capable brick, not good. THIS is what typically gets you in trouble.)
  • ResMed AirSense 10 AutoSet (Fixed CPAP, Auto CPAP) (best choice) (E0601)
  • ResMed AirSense 10 AutoSet for Her (Fixed CPAP, Auto CPAP) (best choice) (E0601)
  • ResMed AirSense 10 Elite (Fixed CPAP) (E0601)
  • Philips Respironics DreamStation Auto CPAP Machine (DSX500x11) (E0601) (S11 is MAachine only, H11 is Heated Humidifier (best choice), T11 is Heated Humidifier and Heated Tube (best choice))
  • Philips Respironics PR System One REMStar 60 Series Auto with Bluetooth (DS560BT) (older model) (E0601)

(All ResMed and Philips Respironics BiPAP machines are fully data capable) be sure to choose the correct BiPAP / BiLevel model to treat your condition.

  • BiPAP / BiLevel / VPAP (E0470)
  • BiPAP ST / BiLevel ST / VPAP ST (E0471)
  • BiPAP SV / BiLevel SV / VPAP SV (E0471)
  • Resmed S9 VPAP Adapt (older model, no longer available from ResMed) (ASV)
  • ResMed AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier (37211) (E0601, E0562) (best choice) (CPAP, BiLevel S, VAuto (Auto-BiLevel))
    • An auto-adjusting bilevel device for patients who need greater pressure support to treat their obstructive sleep apnea. It uses the comfort of both the proven AutoSet algorithm and Easy-Breathe waveform in its VAuto algorithm.
  • ResMed AirCurve™ 10 S BiLevel Machine with HumidAir™ Heated Humidifier (37213) (E0601, E0562) (CPAP, BiLevel S)
    • A bilevel device ideal for patients who need extra pressure support or find it difficult to adjust to therapy on a fixed pressure continuous positive airway pressure device. It features two different adjustable pressures that can help make therapy feel more comfortable.
  • ResMed AirCurve™ 10 ST BiLevel Machine with HumidAir™ Heated Humidifier (E0471)
    • A bilevel device with backup rate that provides exceptional patient-ventilator synchrony, reducing the work of breathing so patients remain comfortable and well ventilated
  • ResMed AirCurve™ 10 ASV BiLevel Machine w/HumidAir™ Humidifier (E0471) (best choice) (CPAP, BiLevel S, VAuto (Auto-BiLevel))
    • A bilevel device for central breathing disorders such as Cheyne-Stokes respiration, central sleep apnea, or obstructive events. The AirCurve 10 ASV targets the patient’s own recent minute ventilation. By treating central breathing disorders with auto-adjusting pressure support, and upper airway obstruction with auto-adjusting expiratory positive airway pressure, the device works to rapidly stabilize breathing.
  • Philips Respironics DreamStation BiPAP Auto Machine (DSX700S11) (best choice)
  • Philips Respironics PR System One REMStar 60 Series BiPAP Auto (older model)

(needed your DME will use this for initial setup) Pressure or Pressure Range: ___________CM/H2O Humidifier(s) (choose 1)

  • Patient Preference (best choice)
  • Heated Humidifier E0562 (best choice)
  • Passover Humidifier E0561

CPAP Mask/Interface/Delivery System:

  • CPAP Mask, Patient Preference (best choice)
  • Other:

Supplies:

  • All Related Supplies

The following dispensable equipment is necessary for the proper use of the equipment and is not a part of the CPAP, BiLevel, BiLevel ST, BiLevel SV or AVAPs machine when purchased and needs to be replaced on a regular basis:

  • Nasal Pillows (A7033)
  • Nasal Mask (A7034)
  • Full Face Mask (A7030)
  • Oral Interface (A7044)
  • Headgear (A7035)
  • Full Face Cushion (A7031)
  • Chinstrap (A7036)
  • Exhalation Port/Swivel (A7045)
  • Tubing (A7037)
  • Heated Humidifier Tubing w/ Heating Element (A4604)
  • Humidifier Chamber (A7046)
  • Mask Cushion (A7032)
  • Disposable Filters (A7038)
  • Non-Disposable Filters (A7039)

Prescription CPAP

Rx

Ordering Physician:
Physician's Address:
Phone:
Fax:

Patient:
DOB:

DAW (Dispense as Written)

Diagnosis:

  • Obstructive Sleep Apnea, Adult Pediatric g47.33

Estimated Lehgth of Service Lifetime

Machine Type

  • ResMed AirSense 10 AutoSet

Pressure or Pressure Range: (value from titration study or Dr) or 14 CM/H2O

Humidifier(s)

  • Heated Humidifier E0562

CPAP Mask/Interface/Delivery System:

  • CPAP Mask, Patient Preference

Supplies:

  • All Related Supplies

The following dispensable equipment is necessary for the proper use of the equipment and is not a part of the CPAP, BiLevel, BiLevel ST, BiLevel SV or AVAPs machine when purchased and needs to be replaced on a regular basis:

  • Nasal Pillows (A7033)
  • Nasal Mask (A7034)
  • Full Face Mask (A7030)
  • Oral Interface (A7044)
  • Headgear (A7035)
  • Full Face Cushion (A7031)
  • Chinstrap (A7036)
  • Exhalation Port/Swivel (A7045)
  • Tubing (A7037)
  • Heated Humidifier Tubing w/ Heating Element (A4604)
  • Humidifier Chamber (A7046)
  • Mask Cushion (A7032)
  • Disposable Filters (A7038)
  • Non-Disposable Filters (A7039)


The above named patient was diagnosed as indicated. Due to the potentially dangerous consequences of disturbed sleep and sleep deprivation, which include the possibility of falling asleep in critical situations, treatment of this condition is considered mandatory rather than elective, on a nightly basis for a long term to lifetime duration (99 months).

Physician's Signature:
NPI:
Date:
License:

Prescription BiPAP VAuto

Rx

Ordering Physician:
Physician's Address:
Phone:
Fax:

Patient:
DOB:

DAW (Dispense as Written)

Diagnosis:

  • Obstructive Sleep Apnea, Adult Pediatric g47.33

Estimated Lehgth of Service Lifetime Machine Type

  • ResMed AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier

Pressure or Pressure Range: (value from titration study or Dr) or Max IPap: 25 Min EPap: 10 CM/H2O, PS: 6 CM/H2O Ramp !5 Mode: VAuto

Humidifier(s)

  • Heated Humidifier E0562

CPAP Mask/Interface/Delivery System:

  • CPAP Mask, Patient Preference

Supplies:

  • All Related Supplies

The following dispensable equipment is necessary for the proper use of the equipment and is not a part of the CPAP, BiLevel, BiLevel ST, BiLevel SV or AVAPs machine when purchased and needs to be replaced on a regular basis:

  • Nasal Pillows (A7033)
  • Nasal Mask (A7034)
  • Full Face Mask (A7030)
  • Oral Interface (A7044)
  • Headgear (A7035)
  • Full Face Cushion (A7031)
  • Chinstrap (A7036)
  • Exhalation Port/Swivel (A7045)
  • Tubing (A7037)
  • Heated Humidifier Tubing w/ Heating Element (A4604)
  • Humidifier Chamber (A7046)
  • Mask Cushion (A7032)
  • Disposable Filters (A7038)
  • Non-Disposable Filters (A7039)


The above named patient was diagnosed as indicated. Due to the potentially dangerous consequences of disturbed sleep and sleep deprivation, which include the possibility of falling asleep in critical situations, treatment of this condition is considered mandatory rather than elective, on a nightly basis for a long term to lifetime duration (99 months).

Physician's Signature:
NPI:
Date:
License:

Prescription APAP

Rx

Ordering Physician:
Physician's Address:
Phone:
Fax:

Patient:
DOB:

DAW (Dispense as Written)

Diagnosis:

  • Obstructive Sleep Apnea, Adult Pediatric g47.33

Estimated Lehgth of Service ___ lifetime / 99 ___ Months

Machine Type

  • ResMed AirSense 10 AutoSet

Pressure or Pressure Range: (value from titration study or Dr) or 8-20 CM/H2O, EPR 2 CM/H2O

Humidifier(s)

  • Heated Humidifier E0562

CPAP Mask/Interface/Delivery System:

  • CPAP Mask, Patient Preference

Supplies:

  • All Related Supplies

The following dispensable equipment is necessary for the proper use of the equipment and is not a part of the CPAP, BiLevel, BiLevel ST, BiLevel SV or AVAPs machine when purchased and needs to be replaced on a regular basis:

  • Nasal Pillows (A7033)
  • Nasal Mask (A7034)
  • Full Face Mask (A7030)
  • Oral Interface (A7044)
  • Headgear (A7035)
  • Full Face Cushion (A7031)
  • Chinstrap (A7036)
  • Exhalation Port/Swivel (A7045)
  • Tubing (A7037)
  • Heated Humidifier Tubing w/ Heating Element (A4604)
  • Humidifier Chamber (A7046)
  • Mask Cushion (A7032)
  • Disposable Filters (A7038)
  • Non-Disposable Filters (A7039)


The above named patient was diagnosed as indicated. Due to the potentially dangerous consequences of disturbed sleep and sleep deprivation, which include the possibility of falling asleep in critical situations, treatment of this condition is considered mandatory rather than elective, on a nightly basis for a long term to lifetime duration (99 months).

Physician's Signature:
NPI:
Date:
License:

Medicare CPAP Qualifications

CPAP Qualifications (E0601) Patient must meet all the following criteria to qualify for an E0601 device (CPAP)

  • Patient has had a face-to-face clinical evaluation
    • by treating physician prior to sleep test.
  • Patient has had a sleep test which meets Medicare Requirements.
    • that meets either of the following criteria:
      • AHI/RDI3 is ≥ 15 events per hour with minimum of 30 events; or,
      • AHI/RDI is ≥ 5 and ≤ 14 events per hour with minimum of 10 events and documentation of excessive daytime sleepiness, impaired cognition, mood disorders, insomnia, hypertension, ischemic heart disease or history of stroke. See back for additional information.
  • Diagnosed with OSA (ICD-9 code of 327.23)
  • Patient and/or caregiver has received instruction from the supplier of the CPAP device and accessories in the proper use and care of the equipment.

Medicare BiPAP Qualifications

Bilevel Qualifications (E0470) (Follow for CPAP to bilevel conversion) Patient must meet all the following criteria to qualify for an E0470 device (bilevel without a backup rate)

  • Patient is qualified for E0601 (CPAP)
  • Treating physician documented both of the following issues were addressed prior to changing a patient from an E0601 to an E0470 device due to ineffective therapy:
    • An appropriate interface has been properly fitted and the beneficiary is using it without difficulty. The properly fitted interface will be used with the E0470 device; and
    • The current pressure setting of the E0601 prevents the beneficiary from tolerating the therapy, and lower pressure settings of the E0601 were tried but failed to:
      • Adequately control the symptoms of OSA; or
      • Improve sleep quality; or
      • Reduce the AHI/RDI to acceptable levels.
  • Yes or No Has CPAP been used < 3 months? (ie, CPAP is tried and found ineffective during the initial 3-month home trial)
    • If “No” a new initial face-to-face clinical evaluation is required but not a new sleep test. A new 3-month trial would begin for use of the bilevel.
    • If “Yes” the patient is qualified for an E0470 device (bilevel without a backup rate, such as VPAP Auto).

Medicare BiPAP ASV Qualification

holding for development


External Medicare Links

Sleep apnea & Continuous Positive Airway Pressure (CPAP) devices & accessories

Medicare Replacement Schedule

United States Medicare Replacement Schedule

Item Frequency
A7034 CPAP Mask (Every 3 months)
A7035 CPAP Headgear (Every 3-6 months)
A7036 CPAP Chin Strap (Every 6 months)
A7037 CPAP Tubing (Every 3 months)
A7038 Disposable Filter (2 new filters every month)
A7039 Non-disposable Filters (1 new filter every 6 months)
A7030 Full Face Mask (Every 3 months)
A7029 Nasal Pillows (2 per month)
A7046 Humidifier Chamber (Every 6 months)
E0601 CPAP (Generally, 3 to 5 years)

This is not a complete list, check with your individual insurance company.