CMS Reimburses Sleep Apnea CPAP Treatment When Diagnosed with Home Testing

Although reimbursement may take some time to work out, Dr. Wardrop noted that private insurers will most likely follow the current CMS ruling and cover CPAP diagnosed with home testing. I believe insurers will follow, but with specific variations, she said. For instance, the Kentucky local carrier determinations went a little further than CMS in specifying that home monitoring should follow AASM guidelines, she explained.

Deciding on the Type of Home Testing

If otolaryngologists opt to acquire home monitoring devices to diagnose sleep apnea, they will have to investigate various available models to decide which ones will work for them, said Dr. Collop. No studies have compared one instrument with another to determine which is the most accurate, and each device has its limitations, she said.

Dr. Davidson has used most brands of home testing during his years of practice and finds that all work quite well. There aren’t Cadillac or fly-by-night products, he said.

The CMS ruling covers three types of home testing devices. The first is Type II, which has a minimum of seven channels, including electroencephalogram (EEG), electro-oculogram (EOG), electromyogram (EMG), electrocardiogram (ECG)-heart rate, airflow, oxygen saturation, and sleep staging, which allows for apnea-hypopnea index (AHI) calculation.

Type III monitors are covered and have a minimum of four channels, including two measuring ventilation or airflow, and the others measuring heart rate or ECG, and oxygen saturation.

Last, CMS covers Type IV devices that measure three or more parameters. The CMS ruling suggests these devices should have a minimum of three parameters but doesn’t tell you what those parameters are, noted Dr. Collop.

When trying to decide on a home testing device, physicians should also refer to AASM guidelines, said Dr. Collop. The guidelines state that at a minimum, home testing or portable monitoring (PM) must record airflow, respiratory effort, and blood oxygenation. The airflow, effort, and oximetric biosensors conventionally used for in-laboratory PSG should be used in PM.

The device also needs to display raw data with the capability of manual scoring or editing of automated scoring by a qualified sleep technician. Furthermore, experienced sleep technicians should be available to show patients how to use the home monitoring equipment, the guidelines state.

Although she does not recommend one brand over another, Dr. Wardrop notes that of the many options available for home monitoring, the Embletta (Embla Systems, Broomfield, CO) meets all the criteria of the AASM practice parameters. The company’s Web site states that it is compliant with CMS recommendations.