Appendix E - National Coverage Determinations Manual / Continuous Positive Airway Pressure (CPAP) Therapy For Obstructive Sleep Apnea (OSA) 240.4

Why This Topic Matters

CPAP coverage depends on specific Medicare policy criteria and documentation-related requirements, so understanding this guidance helps support accurate claims handling and policy compliance for sleep apnea services.

Article Sections

1. A. General

   Provides background on CPAP therapy and defines core sleep-apnea measurement terms used in the coverage policy. It also identifies the sleep-study modalities referenced in the determination.

2. B. Nationally Covered Indications

   Summarizes the Medicare coverage framework for adult CPAP therapy, including the effective date, initial coverage period, diagnostic evaluation requirements, and the research-based coverage pathway.

3. C. Nationally Non-covered Indications

   Addresses diagnostic testing language that is excluded from coverage for CPAP-related diagnosis under the policy.

4. D. Other

   Contains the closing administrative section of the determination.