Medicare replacement schedule

Is there a recent change to the Medicare CPAP equipment replacement schedule? Can someone please link to the current schedule? Thanks!

This is the only one that I have found that actually shows 2012 on it.
http://www.resmed.com/us/documents/1013 ... sories.pdf

There is likely a schedule deep within the actual Medicare stuff from the government but I haven't looked deep within those files.
This is the first one that I have seen that doesn't mention the machine itself though. I have heard that the 5 year thing has been changed to "only if not repairable" but I haven't actually seen that in print...only rumor.

Here is the link to the Medicare LCD, the replacement schedule is about halfway down. No there is no new requirement for the PAP to be irrepairable AFTER 5 years, that only applies if you are trying to replace one PRIOR to 5 years. Also of note near the bottom is the section about supply refills and Rx requirement. They are a few times when Medicare requires a new Rx, one of them being when the State law requires it.

https://www.noridianmedicare.com/dme/co ... _apnea.htm

akcpapguy wrote:
https://www.noridianmedicare.com/dme/co ... _apnea.htm

That link doesn't work for me.

SleepingUgly wrote:

akcpapguy wrote:
https://www.noridianmedicare.com/dme/co ... _apnea.htm

That link doesn't work for me.

Worked with IE9, but not with Chrome for me.

Link worked for me but I had to "accept" some sort of agreement to get to the next page.
Using FireFox.

this is what is said about machines.
"If a PAP device is replaced during the 5 year reasonable useful lifetime (RUL) because of loss, theft, or irreparable damage due to a specific incident, there is no requirement for a new clinical evaluation, sleep test, or trial period.

If a PAP device is replaced following the 5 year RUL, there must be a face-to-face evaluation by their treating physician that documents that the beneficiary continues to use and benefit from the PAP device. There is no requirement for a new sleep test or trial period."


SU if you still can't get it to open let me know and I will get some screen shots but it appears to be the same as the link I posted above for all the other supplies.

Let me try this link.
https://www.noridianmedicare.com/dme/co ... nea.htm%3f

Try this link, and scroll down until you see the PAP LCD.


https://www.noridianmedicare.com/dme/coverage/lcd.html

The rep from SHIIP gave me this link from Resmed.
Apparently Medicare is not into making this easy for us, so other sources are advised:
http://www.resmed.com/us/documents/1013 ... ilevel.pdf
I know; it's not a schedule--I have to ask her again specifically.

Try this:
http://www.respironics.vgm.com/files/Me ... t-2012.pdf

SU, curious--is someone trying to tell you there's been a change?

Some DME's "make up" changes to suit their own needs. I also think that there are so many rumors flying around about what Medicare does or plans to do, and then this becomes what everyone THINKS the rule is--kind of an urban myth process for DME coverage. I used to see that all the time when I worked in healthcare. That's why it's always best to do what you are doing--confirm it from the "horse's mouth".

Don't forget, you can call your state SHIP or HICAP program (number on the back of your Medicare and You book) and they will help you find the answer for free.

My father said his DME told him that Medicare changed their schedule Sept. 1 making it a longer period (for replacement, I assume) and that there has to be some justification for new equipment for Medicare to pay. Otherwise, use the same old equipment. More than that, I don't know.

SleepingUgly wrote:My father said his DME told him that Medicare changed their schedule Sept. 1 making it a longer period (for replacement, I assume) and that there has to be some justification for new equipment for Medicare to pay. Otherwise, use the same old equipment. More than that, I don't know.

regarding what equipment?

Janknitz wrote:Don't forget, you can call your state SHIP or HICAP program (number on the back of your Medicare and You book) and they will help you find the answer for free.

this is the best way to get an accurate answer unless of course you provide more information. ie: equipment needing replacement.

REPLACEMENT:

This section applies to PAP devices initially provided and covered while the beneficiary was in Medicare fee-for-service (FFS).

If a PAP device is replaced during the 5 year reasonable useful lifetime (RUL) because of loss, theft, or irreparable damage due to a specific incident, there is no requirement for a new clinical evaluation, sleep test, or trial period.

If a PAP device is replaced following the 5 year RUL, there must be a face-to-face evaluation by their treating physician that documents that the beneficiary continues to use and benefit from the PAP device. There is no requirement for a new sleep test or trial period.

I remember a thread recently about this. It had to do with supplies also. I think what it boiled down to is trying to put a stop to automatic re-supply. In other words, the replacement schedule still holds, but just because 1 month has passed they are not automatically going to cover a new mask cushion, there has to be some documentation on the part of the DME that a new cushion was actually needed.

This makes sense, because I think the tendency was for DME's to talk you into replacing according to the schedule whether or not you needed it (and all of us end up with a stash at home at some point). However, I haven't actually eyeballed any specific Medicare guideline, but I think whomever posted on the other thread had the verbiage.

BCBS has no replacement schedule that I can find even in my coverage docs. It just says when replaced is needed. Now those replacement parts have to be pre-authorized starting in October.