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What does Medicare cover towards CPAP

This area is for CPAP Mask and CPAP Machine Related Questions used in the treatment of Sleep Apnea.


What does Medicare cover towards CPAP

Postby Alex24 » Sun Jul 22, 2007 6:34 pm

Hi...I am on medicare and have sleep apnea. I had my sleep studies (two of them) My AHI was 77.3 which puts me into the 'bad' category. My sleep study prescription write up reads as .......

"A Synchrony or comparable CPAP/BIPAP device with a Respironics Comfort 2 full-face mask, size large, to be used with BIPAP with an IPAP of 11 and an EPAP of 7 for sleep with heated humidity bled in."

Now I have been trying to find out exactly what type of equipment this is supposed to mean (I know about the mask), but the machine is a bit confusing. The only equipment I found that uses the term "Synchrony" is the high end machine from Respironics. Now if this is what is meant by my prescription, will medicare cover this high end equipment. Is anyone using this type of equipment and did medicare cover it. What do you think they meant by 'comparable' device?"

Any insight would be helpful. I want to get the equpment that I need for my apnea. Thanks.
Alex24
 
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Joined: Sun Jul 15, 2007 12:15 pm

Postby Amos » Sun Jul 22, 2007 6:45 pm

If your DME accepts Medicare, here is what they will pay:

Medicare will pay 80% of the cost that they have an agreement with the DME for your original machine, mask, and other supplies.

Medicare will pay 80% of the cost that they have an agreement with the DME for a new hose and filters each month.

Medicare will pay 80% of the cost that they have an agreement with the DME for a new mask every 3 months.

Medicare will pay 80% of the cost that they have an agreement with the DME for new head gear every 6 months.
Amos
 
Posts: 136
Joined: Thu Sep 07, 2006 7:18 pm
Location: Clarkston, GA

Postby Alex24 » Sun Jul 22, 2007 6:54 pm

Amos wrote:If your DME accepts Medicare, here is what they will pay:

Medicare will pay 80% of the cost that they have an agreement with the DME for your original machine, mask, and other supplies.

Medicare will pay 80% of the cost that they have an agreement with the DME for a new hose and filters each month.

Medicare will pay 80% of the cost that they have an agreement with the DME for a new mask every 3 months.

Medicare will pay 80% of the cost that they have an agreement with the DME for new head gear every 6 months.


Amos...I know tht medicare covers 80%, but is there a limit on the type of equipment? The high end equpment is about $3000. Might they question that?
Alex24
 
Posts: 70
Joined: Sun Jul 15, 2007 12:15 pm

Postby Amos » Sun Jul 22, 2007 7:02 pm

Alex24,

Two things to remember here. The first is that your doctor must write a prescription for the equipment that he decides that you need. That is what the DME must supply, just as a pharmacist must fill the prescription just as the doctor wrote it.

Second, Medicare has a set figure that they will pay for each item, regardless of the list price of the DME for that item.

Amos
Amos
 
Posts: 136
Joined: Thu Sep 07, 2006 7:18 pm
Location: Clarkston, GA



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