DME Guide to Policies, Laws, and Regulations

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Regulation and Coverage Policy Links

The Centers for Medicare and Medicaid Services (CMS) committee released a landmark decision in 2008 to update the National Coverage Determination (NCD) for CPAP. This decision allowed Home Sleep Testing (HST) to be used to qualify patients with Obstructive Sleep Apnea (OSA) for CPAP therapy. You will find helpful links to related coverage policies, decision memos, and so on below. (These may be updated frequently and are for reference purposes only, please see the official Medicare or local carrier sites for the most recent details.)

Medicare Home Sleep Test Coverage Policies

Current Federal and local Medicare policies strictly prohibit Durable Medical Equipment (DME) providers that supply CPAP to delivering home sleep test devices to Medicare beneficiaries or perform home sleep tests. Vitalistics™ testing process works in favor of DME’s, allowing them to still market their services to Medicare beneficiaries while we handle everything else.

National Coverage Determinations (NCD)

NCD 240.4 Pub 100-2 for CPAP

National Coverage Decision Memos (NCA)

Decision Memo for CPAP – Home Sleep Testing
Decision Memo for Sleep Testing – Obstructive Sleep Apnea

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

Jurisdiction A- NHIC
Jurisdiction B- National Government Services
Jurisdiction C- Cigna
Jurisdiction D- Noridian

Medicare DME Guidelines

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