Based on a request to reconsider the 2005 National Coverage Determination (NCD) for Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA) to allow coverage of CPAP based upon a diagnosis of OSA by home sleep testing (HST), the Centers for Medicare and Medicaid Services (CMS) have announced changes to their NCD on the topic. The Academy commented in favor of the proposed expansion, but outlined individual concerns with portions of the NCD revisions.
Among the changes, coverage of CPAP is initially limited to a 12-week period for beneficiaries diagnosed with OSA. CPAP is subsequently covered for those beneficiaries diagnosed with OSA whose OSA improved as a result of CPAP during this 12-week period. Secondly, CMS is deleting the distinct requirements that an individual have moderate to severe OSA and that surgery is a likely alternative to CPAP therapy.
CMS also outlined in its announcement numerous standards that must be met by clinical studies seeking Medicare payment for CPAP provided to the beneficiary pursuant to Coverage with Evidence Development (CED).