Table 2.

Suggested Changes to the Current Coverage Policies to Improve Access to the Right Treatments in a Timely Fashion

•A single definition of CSA will simplify and clarify coverage decisions

•The discussion for CSA should not refer to hypoventilation

•Qualifying symptoms for CSA therapy should be the same symptoms that qualify a patient for OSA therapy

•All effective therapies for CSA should be covered by CMS. CPAP, BPAP, and PAP devices with a backup rate such as E0471 (including BPAP S/T, servoventilation, and volume-assured pressure support) and oxygen are effective for select patients

•Patients with CSA frequently need E0471 therapy. Coverage of E0471 for these patients should not require prior failure of BPAP without a backup rate.23 Patients with suboptimal response with one E0471 device should be allowed to switch to a different E0471 device if shown to be effective with testing

•The requirements for continuing coverage for CSA therapy should be the same as for continuing coverage for OSA therapy

BPAP = bilevel positive airway pressure; CMS = Centers for Medicare & Medicaid Services; CSA = central sleep apnea; PAP = positive airway pressure; S/T = spontaneous/timed.