possibility of using auto cpap w/o local DME?

[macademia]

I would like to purchase a new auto cpap. How does one learn the medicare requirements for upgrading an old machine to newer model? Also is it possible to manage without a local DME and purchase Apap on web as long as one has a sleep doctor? Thanks

[Janknitz]

If you have a valid prescription from any licensed physician, you can purchase an autopap from an online supplier and completely bypass local DMEs, BUT don't expect Medicare to pay for it. They won't. Even though it costs a lot less, Medicare will only pay for CPAP equipment and supplies from accredited DME companies.

If you already have a machine provided by Medicare, you MAY be able to get Medicare to cover a new machine, RENTED (not purchased, initially) from an accredited DME. And if Medicare is your primary insurance, you can get any machine that falls under the HCPC code E0601 (cpap, apap, data capable or not) IF you qualify for a new machine under medicare. But these are the criteria you must meet:
1. You will probably need a new sleep study to verify that you still have apnea
2. Unless your machine is no longer working, you will not be eligible for a machine if Medicare purchased the one you have within the last 5 years or so.
3. You will need a new prescription. While not strictly necessary (for Medicare), it's a good idea to have the doctor specify that you need an auto-adjusting machine with patient access to AHI and leak rate (in other words, data capable). Otherwise the DME will try to tell you that you don't qualify for an auto-pap (not true).