Instruction manual
Medicare Capped Rental Information for CPAP/BiPAP/VPAP (ow generator)
You have been prescribed Continuous Positive Airway Pressure (CPAP) for treatment of obstructive sleep apnea.
In most patients, CPAP is used indenitely. Medicare covers CPAP, but the initial coverage is limited to three months.
Long-term Medicare coverage depends on demonstrating to your treating doctor that you are using your CPAP on a
regular basis.
Here are the specifics
The following two things must happen within the rst 90 days on CPAP for Medicare to cover your CPAP indenitely
1. Use of CPAP on a regular basis: During the rst three months Medicare mandates that you must use CPAP at
least four hours per night on at least 70% of nights during a consecutive 30-day period. Ideally, CPAP should be
used all night, every night. Without it, your obstructive sleep apnea will come back. However, it is understood
there will be circumstances when CPAP use will be temporarily disrupted, such as when you have a bad cold or
are traveling. To meet the Medicare rules, you must use your CPAP a minimum of four hours per night for at least
21 nights over any given consecutive stretch of 30 days. Don’t worry about keeping track of your hours of CPAP
use. Your CPAP will have an internal usage meter.
2. Face-to-face visit in the Mayo Center for Sleep Medicine 31-90 days after starting the CPAP. We need to make
sure you are benetting from CPAP and using it on a regular basis. This follow-up cannot be done by phone. You
are certainly welcome to call the Center for Sleep Medicine if you need troubleshooting help with CPAP, but you
must be seen in person to review matters before 90 days with CPAP has passed. It is crucial that you bring your
CPAP equipment to the follow-up appointment. If you are not meeting the CPAP use requirements, several more
visits for adjustments may be necessary until you establish regular CPAP use.
If conditions 1 and 2 above are not met after 90 days, Medicare coverage for CPAP will stop. If you decide to
restart CPAP anytime in the future, Medicare requires a face-to-face visit in the Mayo Center for Sleep Medicine and
a repeat sleep study.
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