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Issue Number - Name
0066 - Complex PAP Devices for the Treatment of Obstructive Sleep Apnea
Review Type
Complex
Claim Type
DME Supplier, DME by Physician
Region and State
RAC 5
All States
Date Approved
2017-09-07

Description

Medical necessity review: Documentation will be reviewed to determine if PAP Devices for the Treatment of Obstructive Sleep Apnea meet coverage criteria.

Affected Code(s)

  • E0601, E0470

Applicable Policy References

  • 42 C.F.R. Sections 405.980 (b)&(c) and Section 405.986
  • CMS Pub. 100-03, Medicare National Coverage Determination Manual, Section 240.4  
  • CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 110
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 4, Section 4.26
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Section 5.2.4–5.2.8, 5.7, 5.8, and 5.9
  • CGS and Noridian Healthcare Solutions LCD, L33718, Effective 10/01/2015
  • CGS LCD, L11518, Effective date 10/01/1993, Retired 09/30/2015
  • NGS LCD, L27230, Effective date 10/01/1993, Retired 09/30/2015
  • NHIC LCD, L11528, Effective date 10/01/1993, Retired 09/30/2015
  • Noridian LCD, L171, Effective date 10/01/1993, Retired 09/30/2015
  • CGS and Noridian Healthcare Solutions Article, A52467, Effective 10/01/2015
  • CGS Article, A20195, Effective date 07/01/2004, Retired 09/30/2015
  • NGS Article, A47228, Effective date 07/01/2004, Retired 09/30/2015
  • NHIC Article, A19815, Effective date 07/01/2004, Retired 09/30/2015
  • Noridian Article, A19827, Effective date 07/01/2004, Retired 09/30/2015
  • CMS Policy Article, A55426, Effective date: 01/01/2017