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Specifically for the treatment of OSA, a respiratory assist device with bilevel pressure capability, without backup rate feature, used with noninvasive interface (K0532) will be covered for the first three months of noninvasive positive pressure respiratory assistance (NPPRA) if the following criteria are met: CMS met with the American Academy of Sleep Medicine (AASM).AASM asked us to revise the national coverage policy and to include allowance for hypopneas in the diagnosis of patients with moderate or severe OSA.Apnea is defined as a cessation of airflow for at least 10 seconds.Hypopnea is defined as an abnormal respiratory event lasting at least 10 seconds with at least a 30% reduction in thorocoabdominal movement or airflow as compared to baseline, and with at least a 4% oxygen desaturation.OHTA reported that "the consensus of clinical opinion from the available information appears to be that CPAP can in the majority of cases prevent OSA and provide substantial clinical improvement with minimal associated morbidity." They went on further to recommend that "the use of CPAP be covered under Medicare when used in adult patients with moderate and severe OSA who have failed to obtain relief from other non-invasive therapies and for whom surgery would be the only other therapeutic alternative." The diagnosis of OSA required at least 30 episodes of apnea, each lasting a minimum of 10 seconds, during 6-7 hours of sleep.These specifications were based predominately on expert opinions at the time.
Obstructive sleep apnea (OSA) refers to apnea syndromes due primarily to collapse of the upper airway during sleep.Hypopneas and the AHI will be discussed in greater detail later in this decision.In 1986, the Centers for Medicare and Medicaid Services (CMS - then known as the Health Care Financing Administration) requested the Office of Health Technology Assessment (OHTA) to conduct an assessment of the safety, clinical effectiveness and use of CPAP.Mixed apnea refers to apnea with both central and obstructive characteristics.The pathogenesis and pathophysiology of OSA has been studied extensively.
With the return of breathing, the patient typically returns to sleep quickly. The pharynx has been identified as the primary site of obstruction in most patients.