Continuous Positive Airway Pressure (CPAP) Device Qualifying Criteria
A CPAP device is covered if the patient has a diagnosis of obstructive sleep apnea (OSA) documented by an attended, facility-based polysomnogram and meets either of the following criteria (1 or 2):
1. The apnea-hypopnea index (AHI) is greater than or equal to 15 events per hour, or
2. The AHI is from 5 to 14 events per hour with documented symptoms of:
a. Excessive daytime sleepiness, impaired cognition, mood disorders, or
insomnia; or,
b. Hypertension, ischemic heart disease, or history of stroke.
The AHI is defined as the average number of episodes of apnea and hypopnea per hour and must be based on a minimum of 2 hours of sleep[i] without the use of a positive airway pressure device, reported by polysomnography using actual recorded hours of sleep (i.e., the AHI may not be extrapolated or projected).
[i] This guideline is currently under review by Medicare and will be updated as needed/necessary.