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Continuous Positive Airway Pressure (CPAP) Therapy

Issue: Recovery Auditors found that suppliers bill for Positive Airway Pressure (PAP) and Respiratory Assist Device (RAD) accessories in quantities that exceed the determined medically-necessary amounts.

Solution: Suppliers can avoid overpayment by developing or enhancing edits to identify DME claims when there is overutilization of PAP/RAD accessories. Some audits are most efficiently handled through post-pay review. For additional guidance, please refer to MLN Matters® Article #MM6048 and "Medicare National Coverage Determination Manual," Chapter 1, Section 240.4.