Medicare Coverage Guidelines For Sleep Therapy Change Again.

Medicare has recently changed the guidelines for continued coverage on sleep therapy equipment. Most of us are familiar with the coverage guidelines instituted by Medicare a while back. If your not familiar or just forgot here is the gist of it. Sleep Therapy patients must use their cpap 4 hours a night, 70% of nights within a 30 day period. Compliance reports are generated by the patients cpap machine that show if the patient has in fact used their machine enough to qualify for continued coverage. They also must have a face to face visit with their physician during the second or third month after being set up. During the visit the physician must document an improvement of symptoms. This process can be challenging for patients because it needs to be done within 90 days.
This is where the new piece to the coverage guidelines comes in. If a sleep therapy patient doesn't meet the above stated criteria and wishes to continue trying cpap they must go for another sleep study. The reasoning behind the new study is to help determine why the patient was unable to become compliant within in the 90 days. Secondly new findings may be made after the new study that could lead to a different form of treatment like Bilevel.