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Regulation and Coverage Policies

In March of 2008, the Centers for Medicare and Medicaid Services (CMS) committee released a landmark decision to update the National Coverage Determination (NCD) for CPAP. This decision opened the door to Home Sleep Testing (HST) as a means to qualify patients with Obstructive Sleep Apnea (OSA) for CPAP therapy. Below are links to many of the coverage policies, decision memos, etc. (These are subject to change, please review official Medicare or local carrier sites.)

Medicare Home Sleep Test Coverage Policies

The Federal and local Medicare policies below strictly prohibit HME suppliers that supply CPAP from performing or delivering HST devices to Medicare beneficiaries. The IDS program is designed to work cooperatively with HMEs who are still allowed to market our services to referring physicians, as long as IDS handles the rest. 

National Coverage Determinations (NCD)

National Coverage Decision Memos (NCA)

DME MAC CPAP Local Coverage Determinations (LCDs) for CPAP (as of March 20, 2009)

These are the policies which govern CPAP suppliers.

Medicare Part B Medical Policy for OSA Testing

  • Cahaba GBA - Covers all testing performed by IDS. This region published a final Local Coverage Determination in March 2009, only to rescind it later to allow the National Coverage Determination regulations to cover all providers in this region for now.