Will Medicare pay for a change to a BIPAP machine?

barney999 · Post by **barney999** » Thu Jan 06, 2022 2:16 pm

I've been on APAP (ResMed10 Autosense) for 15 months. I recently saw my sleep doctor who thought a BIPAP machine might work better for me, but I need to do another sleep study first, which I don't plan to do until the Covid surge settles down.

Anyway, will Medicare pay for the BIPAP machine if the sleep doctor recommends the change?

greatunclebill · Post by **greatunclebill** » Thu Jan 06, 2022 2:35 pm

If the doctor justifies it with a sleep study, medicare will pay for it.

Janknitz · Post by **Janknitz** » Thu Jan 06, 2022 3:44 pm

Ask if you can do a home sleep study. This generally involves wearing something around your wrist that attaches to two fingers. Some have a chest strap as well. These tests are approved by Medicare.

Here's a good article that describes coverage for a BIPAP. It's not Medicare-specific, but the guidelines are the same. https://www.sleepdr.com/the-sleep-blog/ ... level-pap/

Keep in mind that if you have out of pocket co-pays, they will be higher for a BIPAP and don't forget the annual deductibles.

SleepGeek · Post by **SleepGeek** » Thu Jan 06, 2022 5:08 pm

barney999 wrote: ↑
Thu Jan 06, 2022 2:16 pm
I've been on APAP (ResMed10 Autosense) for 15 months. I recently saw my sleep doctor who thought a BIPAP machine might work better for me, but I need to do another sleep study first, which I don't plan to do until the Covid surge settles down.

Anyway, will Medicare pay for the BIPAP machine if the sleep doctor recommends the change?

Certainly they will. While Medicare will cover an at home study I think what your doc wants is not the study but a titration to find a good working pressure for you. That is what a good doc would want to save you some time and trouble.

The at home study is often used to find out if you have sleep apnea and if you do often will have to go "in lab" for a titration.

Even after the titration you may need some fine tuning at home but I think you will like the bipap so much better. What is your pressure now?

Covid like other viruses will likely be around as long as we are so that wait is up to you. Talk that over with your doc.

barney999 · Post by **barney999** » Thu Jan 06, 2022 7:36 pm

Janknitz wrote: ↑
Thu Jan 06, 2022 3:44 pm
Ask if you can do a home sleep study.

He wants the sleep lab study. Thanks for the link about BIPAP.

barney999 · Post by **barney999** » Thu Jan 06, 2022 7:38 pm

greatunclebill wrote: ↑
Thu Jan 06, 2022 2:35 pm
If the doctor justifies it with a sleep study, medicare will pay for it.

Thanks for the info! That was good to hear.

BlueDragon · Post by **BlueDragon** » Thu Jan 06, 2022 9:50 pm

Medicare will pay for it if your doctor orders it. Medicare does not require a sleep study. All that is needed is for your APAP treatment to have "failed."

I had a similar situation to yours a year ago. After using APAP for a year, I wasn't feeling that rested, even though average AHI was less than 2. I presented a case to my GP that APAP treatment had "failed" to achieve the treatment goals and he immediately ordered a AirCurve 10 VAuto. I had borrowed a VAuto for a month before that, had titrated myself, and demonstrated I was sleeping better and had a low AHI (even saw some 0.0 for the first time).

I'm sure it helped that I have a very good relationship with my GP and am technically-minded myself.

barney999 · Post by **barney999** » Thu Jan 06, 2022 10:16 pm

I noticed that I wasn't really clear that Medicare bought my first machine in my original question, so just to be sure....

If Medicare paid for my first APAP machine, which I bought 15 months ago, will they also pay for a new BIPAP machine, if my sleep doctor recommends it after a sleep lab study? TIA.

Pugsy · Post by **Pugsy** » Thu Jan 06, 2022 10:25 pm

barney999 wrote: ↑
Thu Jan 06, 2022 10:16 pm
If Medicare paid for my first APAP machine, which I bought 15 months ago, will they also pay for a new BIPAP machine, if my sleep doctor recommends it after a sleep lab study? TIA.

Yes....Medicare will pay for a different machine as long as the doctor recommends it and you have the needed supporting documentation to prove the need.
As long as the need is proven...Medicare will pay for a new different machine.
This happens from time to time and really isn't all that unusual. Maybe someone ends up needing a different machine than what was originally thought to be needed.
As long as the doctor can prove the need....Medicare will pay for another machine.

barney999 · Post by **barney999** » Thu Jan 06, 2022 10:35 pm

BlueDragon wrote: ↑
Thu Jan 06, 2022 9:50 pm
Medicare will pay for it if your doctor orders it. Medicare does not require a sleep study. All that is needed is for your APAP treatment to have "failed."

I had a similar situation to yours a year ago. After using APAP for a year, I wasn't feeling that rested, even though average AHI was less than 2. I presented a case to my GP that APAP treatment had "failed" to achieve the treatment goals and he immediately ordered a AirCurve 10 VAuto. I had borrowed a VAuto for a month before that, had titrated myself, and demonstrated I was sleeping better and had a low AHI (even saw some 0.0 for the first time).

I'm sure it helped that I have a very good relationship with my GP and am technically-minded myself.

Thanks for the info. My situation with APAP sounds very similar to yours.

How did you borrow the VAuto for a month? I would gladly pay out-of-pocket for either a BIPAP or VAuto for a month. And I believe I could demonstrate the need for a machine change to my GP using OSCAR data, if my sleep improves. So, a GP can write the prescription?

BlueDragon · Post by **BlueDragon** » Thu Jan 06, 2022 10:57 pm

barney999 wrote: ↑
Thu Jan 06, 2022 10:35 pm
How did you borrow the VAuto for a month? I would gladly pay out-of-pocket for either a BIPAP or VAuto for a month. And I believe I could demonstrate the need for a machine change to my GP using OSCAR data, if my sleep improves. So, a GP can write the prescription?

Essentially, I had a friend who was able to loan one to me.

The list of medical professionals who can prescribe CPAP equipment is quite extensive: MD, DO (Doctor of Osteopathy), PA (Physician's Assistant), NP (Nurse Practitioner), Dentist, and Naturopathic Physicians.

I've never seen anyone describing themselves as a "sleep doctor." My wife has, and he was less than helpful, so we now handle any prescriptions she needs through her GP.

barney999 · Post by **barney999** » Fri Jan 07, 2022 12:26 am

BlueDragon wrote: ↑
Thu Jan 06, 2022 10:57 pm
Essentially, I had a friend who was able to loan one to me.

The list of medical professionals who can prescribe CPAP equipment is quite extensive: MD, DO (Doctor of Osteopathy), PA (Physician's Assistant), NP (Nurse Practitioner), Dentist, and Naturopathic Physicians.

I've never seen anyone describing themselves as a "sleep doctor." My wife has, and he was less than helpful, so we now handle any prescriptions she needs through her GP.

Thanks for the additional info.

barney999 · Post by **barney999** » Fri Jan 07, 2022 1:58 am

Pugsy wrote: ↑
Thu Jan 06, 2022 10:25 pm

barney999 wrote: ↑
Thu Jan 06, 2022 10:16 pm
If Medicare paid for my first APAP machine, which I bought 15 months ago, will they also pay for a new BIPAP machine, if my sleep doctor recommends it after a sleep lab study? TIA.
Yes....Medicare will pay for a different machine as long as the doctor recommends it and you have the needed supporting documentation to prove the need.
As long as the need is proven...Medicare will pay for a new different machine.
This happens from time to time and really isn't all that unusual. Maybe someone ends up needing a different machine than what was originally thought to be needed.
As long as the doctor can prove the need....Medicare will pay for another machine.

Thanks Pugsy !

Will Medicare pay for a change to a BIPAP machine?

Will Medicare pay for a change to a BIPAP machine?

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Re: Will Medicare pay for a change to a BIPAP machine?