The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have released revised Local Coverage Determinations (LCDs) for PAP devices for the treatment of OSA. The LCDs incorporate the provisions of CMS’s March 13 National Coverage Determination, while incorporating additional coverage criteria.

The new LCDs contain a number of important revisions. “They revised the definition of type IV devices to loosen the restriction on the channel set that was previously specified, however they added some language that may restrict some other devices,” says Landon Pendleton, director of product development, Instant Diagnostic Systems. Despite the change, Pendleton urged caution “because there may be language in local carriers' medical policies that may still restrict the device type.”

Other revisions were also added to the LCDs. “They provided an alternative to face-to-face instruction,” says Pendleton. “They will now allow prerecorded video instruction supplemented with 24-hour patient support.”
     
For home medical equipment providers hoping to be involved in home testing, the revisions did not contain reason for optimism. “Unfortunately, they did not change the DME delivery or involvement portions of the LCD,” Pendleton says.

The following list highlights where revisions were made to the recently released PAP policy.

Indications and Limitations of Coverage:
Revised: Coverage criteria for documentation of initial evaluation and moved to documentation section.
Revised: Clarified extrapolation of AHI and RDI results.
Revised: Definition of type IV device.
Revised: Extended implementation dates for credentialing of physicians interpreting home sleep tests and facility-based polysomnograms.
Revised: Requirement for beneficiary education by entity conducting home sleep test.
Revised: Expanded dates during which patients must be re-evaluated for documenting benefit from PAP therapy.
Revised: Expanded dates for patients switched from CPAP to RAD with less than 30 days remaining in initial trial period.
Added: Requalifying after failed initial 12-week trial of PAP therapy.

Documentation:
Revised: Expanded dates for documentation of benefit from PAP therapy.
Revised: Documentation of adherence to PAP therapy to allow visual inspection of usage data.

Click here to view the complete Noridian Administrative Services’ policy.

The NHIC policy can be viewed here.

The Cigna policy can be viewed here.

National Government Services has not posted its revisions at press time but is expected to release a document identical to the LCDs released by the other DME MACs.

Related articles
Contractors Put Brakes on PAP LCDs
LCDs Bring Clarity to Home Testing Policy