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Posted 12/21/2012 11:52 PM (GMT 0)
CrohnieToo,

I was looking at a Sleep Apnea forum earlier and saw the user name CrohnieToo and thought you might be one in the same.  If so, I have a question for you concerning CPAP vs APAP.

Thanks,

Jason

Posted 12/22/2012 3:48 PM (GMT 0)
Yes, that's me, Jason. apneasupport dot org. Another good one is cpaptalk dot com. I've used both straight CPAP and APAP and am currently using a bi-level APAP in straight bi-level mode. I started on CPAP in October 2006 and bi-level in 2008. I also use supplemental 02 w/my PAP.
Posted 12/22/2012 8:16 PM (GMT 0)
I previously had an APAP but I lost my insurance, etc.... and had to return the machine. That was in late 2010. I have another sleep study on 01/16.

I want to get another APAP but the sleep study people seem insistant that Medicare will not pay for an APAP until I fail with a CPAP.

However, I called ResMed's reimbursement people and they said that Medicare will pay for either the CPAP or APAP and there is no requirement that I fail the CPAP first. My Medicare plan said the same thing.

I just dont want to be stuck with a CPAP. I hated the one I had during the first sleep study and ended up telling them to take it off (which is why I started with an APAP at home). I had ZERO problems with the APAP so I would prefer to go that route again.

I am looking at the ResMed A9 AutoSet with Climate Control.
Posted 12/23/2012 7:31 AM (GMT 0)
Either the sleep study people are closely affiliated w/a DME provider - or they really are that ignorant about the various style xPAPs and do NOT know the difference between an APAP and a bi-level PAP. Most likely they actually think that an APAP is a bi-level PAP which would account for their saying that you must fail CPAP therapy in order to get an "APAP". Duh.

CPAP and APAP are the exact same HCPCS (insurance) code whilst the bi-levels are an entirely different HCPCS code. Insurances pay by HCPCS code, not by brand and model. Resmed is telling you right, sleep people are telling your wrong. And the Resmed S9 AutoSet is a great way to go.

Obviously the manufacturer charges more for an APAP than for a CPAP. Medicare and insurances pay one set, contracted, fee for HCPCS code e0601 which is the HCPCS code for CPAPs and APAPs so obviously the DME provider makes less money selling you an APAP than selling you a CPAP. Some will do so IF you are diplomatic but pleasant and FIRM.

You may need to explain to theses sleep study people that an APAP is NOT a bi-level PAP and is the exact same code HCPCS code as a CPAP. It would be nice if they would specify HCPCS code e0601 on your script AND a pressure range, i.e. two pressure numbers. If you know what your pressure range was on your previous APAP, use the same pressure range if the sleep study people are reluctant to designate what pressure range to script. Usually it is 1-2 cms below your titrated pressure and 2-3 cms above your titrated pressure in APAP mode.
Posted 12/23/2012 8:20 AM (GMT 0)
My doctor already wrote the Rx. She wrote "A-PAP for Sleep Apnea" on the Rx. The sleep study is just needed to get the auth for the machine.

I will see the doctor again before I have the sleep study and will see if she will write a new Rx for a "ResMed S9 AutoSet A-PAP" with their product code.

I looked up the Medicare guidelines and what you said is 100% correct. I think I will have the ResMed reimbursement people talk to the DME people to make sure it is all done right.

I don't want to be too picky, but I want a quality, comfortable machine. If it is not comfortable I will not be compliant and it will all be a waste.
Posted 12/23/2012 9:49 AM (GMT 0)
If there are two pressures (a pressure range) scripted they have no choice but to provide an APAP. The range should be 4 or more cms since EPR and C-/A-Flex can provide up to 3 cms of pressure relief.
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