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Medicare Ordering & Qualifying Criteria


  Oxygen  
     
    Prescription Must Include:
   
  1. Liter flow
  2. Diagnosis
  3. Frequency
  4. Duration

Example: (02 @ 3LPM for COPD, 24 HPD, lifetime)

CRITERIA:
  1. O2 Saturation results of 88% or less not more than 30 days old
  2. A Saturation of 89% will qualify with additional diagnosis of:

OR

a) Edema resulting from Congestive Heart Failure
b) Cor pulmonale or documented pulmonary hypertension
c) Hematocrit greater than 56%

CPAP  
     
    Prescription Must Not be older than 30 Days and should include:
   
  1. Pressure
  2. Heated Humidifier (if desired)
  3. Type of Mask (if known)

Example: (CPAP @ 10 cmH20 with heated humidifier and nasal pillows)

CRITERIA:
  1. Current (1 year or less) sleep study (polysomnography)
  2. Minimum recording time of 120 minutes
  3. A reported Apnea/Hypopnea Index (AHI) of 15 or greater
  4. An AHI of 5-14 will qualify with an additional diagnosis of:




OR

a) Hypertension
b) Ischemic Heart Disease
c) History of stroke
d) Excessive daytime somnolence
e) Impaired cognition
f) Mind disorder

  BIPAP  
     
    Prescription Must Not be older than 30 Days and should include:
   
  1. IPAP & EPAP Pressures
  2. Heated Humidifiers (if desires)
  3. Mask Type (if known)
  4. Statement that patient was unable to tolerate CPAP

Example: (BIPAP @ 59/9 cmH20 with Heated Humidifier, Medium Full Face Mask, Patient unable to tolerate CPAP

CRITERIA:
  1. Same as CPAP (above)
         
   
 
PLEASE CALL US WITH ANY QUESTIONS OR FOR ASSISTANCE
     
     


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