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##* Full Face mask(s) tried (note model(s) and results)
== DME Says I Need a New Sleep Test ==A DME has no authorization to diagnose, prescribe or otherwise perform any medical function such as referral to sleep tests. The role of the DME is limited to filling a doctor's prescription and coordinating any insurance or Medicare approval, denial and reimbursement activity. Many DME providers also have Respiratory Therapists on staff that setup devices in accordance with prescribed pressure, assist patients with fitting masks, solving therapy problems and tracking usage compliance. The DME is not authorized to change machine settings without a doctor's order, and cannot refer a patient to a sleep test. They can inform a patient or their doctor that information needed to file a claim may be missing or insufficient. It is common for a DME representative to tell a patient they need a new sleep test, however if a valid sleep test has been performed at anytime in the past that meets the requirements of the insurer, and a treating physician has continued to issue a prescription for devices and equipment based on that history, it is not the role of the DME to do anything but submit a claim containing that information to the insurer. There is no mandate for re-testing when a replacement machine is acquired and the patient has been under the care of a physician, regularly discussed their CPAP therapy and indicated it is beneficial. The choice of a device to treat apnea is between the doctor and his patient and can be supported by a titration if the doctor deems it necessary, however; titration exams are never a requirement to obtain a PAP device. Medicare rules are typical. A patient qualifies for CPAP after an in-person clinical evaluation and a positive sleep test using PSG or type II, III or IV home sleep test. While the criteria for a positive sleep test is defined as greater than or equal to 15 events per hour, or 5 or more events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke. [https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=226 CMS Medicare Requirements for CPAP] Once that examination and testing has been satisfied, there is no requirement for a patient to be re-tested, including when obtaining a replacement CPAP. Patients entering Medicare that have been tested before obtaining Medicare coverage will continue to qualify for supplies and equipment provided they have previously met the diagnostic criteria, and have continued to be under the care of a treating physician and demonstrate continued benefits of the use of CPAP. Patients can be considered for bilevel therapy if the treating physician (your doctor) makes the determinations described on this Medicare Policy summary by Resmed:[https://document.resmed.com/en-us/documents/articles Medicare Policy on CPAP and Bilevel] Surround yourselves with a supportive medical team. Stay away from sleep specialists and clinics and DMEs who give you false information that you need more tests. Keep your original sleep tests and records and don't let anyone tell you to take another test. The key to a replacement machine is a treating physician documented that both of the following issues were addressed prior to changing a patient from an E0601 to an E0470 device due to ineffective therapy:* a. An appropriate interface has been properly fitted and the beneficiary is using it without difficulty. The properly fitted interface will be used with the E0470 device; and* b. The current pressure setting of the E0601 prevents the beneficiary from tolerating the therapy, and lower pressure settings of the E0601 were tried but failed to:# 1. Adequately control the symptoms of OSA; or# 2. Improve sleep quality; or# 3. Reduce the AHI/RDI to acceptable levels.
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