Medicare

Is it standard for a Medicare CPAP equipment provider to require a new sleep study after a certain amount of time in order to continue receiving supplies (tubing, masks etc)?

Medicare doesn't require it and the DME/supplier shouldn't either.
If your supplier is making that requirement then I would suggest finding another supplier that accepts Medicare.

Thanks for the information, Pugsy!

If you don't have the choice of another supplier because of insurance coverage, ask the supplier to SHOW YOU THE REGULATION that requires a new sleep study.

bayareacpap wrote: ↑

Tue Jul 26, 2022 9:00 pm

Is it standard for a Medicare CPAP equipment provider to require a new sleep study after a certain amount of time in order to continue receiving supplies (tubing, masks etc)?

No, but you may need a new prescription.

Medicare only requires a yearly letter from your doctor, indicating that
you regularly use cpap, and you benefit from it.
No additional sleep test is needed unless your DOCTOR orders it.
(If regular cpap is insufficient, and you may need to upgrade to an advanced machine.)
The supplier is full of crap.

chunkyfrog wrote: ↑

Wed Jul 27, 2022 11:15 pm

Medicare only requires a yearly letter from your doctor, indicating that
you regularly use cpap, and you benefit from it.
No additional sleep test is needed unless your DOCTOR orders it.
(If regular cpap is insufficient, and you may need to upgrade to an advanced machine.)
The supplier is full of crap.

Usually how long does one need to stay on an insufficient cpap before Medicare relents and allows an upgrade?

chunkyfrog wrote: ↑

Wed Jul 27, 2022 11:15 pm

Medicare only requires a yearly letter from your doctor, indicating that
you regularly use cpap, and you benefit from it.

I had to have a 'face to face' with my doctor at the required 90 days to certify that the CPAP therapy is helping/working for completion of the 'trial' period and so Medicare will continue to pay the rental to own and subsequent supplies. I'm not aware of or has my doctor mentioned any yearly letter he would have provided and I doubt Medicare would contact him requesting a letter. Knowing my doctor, this is not something he would initiate on his own. When I order supplies from my DME I believe there is a checkbox or other asking if I'm still using CPAP, but that's the only place I've ever been asked to acknowledge use.
My 'face to face' was in 2020. Had there been older Medicare requirements that required a yearly letter?

I see my pneumonologist every year, so Medicare has no excuses.