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Prescription - CPAP - APAP - BIPAP

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General Information

written by forum Advisory Member and Wiki Editor bonjour 

(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 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

  • 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.


ResMed BiPAP/BiLevel

  • The AirCurve 10 line includes:
    • 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.
    • 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.
    • 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.
    • 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.
  • 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.


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

  • Basic Full Data Chart

  • Breath by Breath Detail


A non full data Capable machine looks like

  • a Brick

The detailed data is simply just not there.

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

https://www.medicare.gov/coverage/sleep-apnea-and-cpap-devices-and-accessories.htmlSleep apnea & Continuous Positive Airway Pressure (CPAP) devices & accessories




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