 Nasal
CPAP
This is a small machine
which connects to a mask with tubing.
It eases breathing for persons suffering
from obstructive sleep apnea.
Medicare
- Capped rental. The patient must
meet ALL the following criteria:
- Patient has had a minimum
of 2 hours of recorded sleep
- Patient has an Apnea Hypopnea
Index (AHI) greater then 15
events per hour
OR
- The AHI is from 5-14 events
per hours with documented
symptoms of:
a) Excessive daytime sleepiness,
impaired cognition, mood disorders,
or insomnia,
OR
b) Hypertension, ischemic
heart disease, or history
of stroke
Nasal
BIPAP S
This is a small machine
which connects to a mask with tubing.
It eases breathing by providing two
levels of pressure, one for inspiration
and one for exhalation. BIPAP is prescribed
when CPAP does not provide sufficient
therapy.
Medicare
- Capped rental.
Nasal
BIPAP ST
This is a small machine
which connects to a mask with tubing.
It eases breathing by providing two
levels of pressure, one for inspiration
and one for exhalation. BIPAP is prescribed
when CPAP will not provide sufficient
therapy. It is different from the
BIPAP S in that it has a timer which
monitors the breathing rate and cues
patient to breath.
Medicare
- Assigned. Requires a signed doctor's
prescription.
 Nebulizer
with Compressor (a.k.a. Pulmo-Aid,
Aerosol Therapy Unit, & Mini-Neb)
A hand held nebulizer
connected by tubing to a small compressor
which delivers medication in mist
form to help patient take a deep breath.
Medicare
- Capped rental. Requires a physician's
prescription, indicating the patient's
ability to breathe is severely impaired.
 Oxygen
Concentrator
This is an electronically
driven unit with a series of filters
which extract oxygen from room air.
A humidifier is attached if moisture
is necessary. Regular household current
is sufficient for its use. A compressed
gas unit can be used as a back up
in case of power failure.
Medicare
- Tests measuring oxygen in the blood
are required. Either PO2 or SaO2 (saturation)
must be documented. Tests should be
taken on room air. Coverage when there
are the following test indications:
- PO2 of 55 or less, SaO2 if 88%
or less, during exercise or sleep
for one year.
- PO2 of 56-59, or SaO2 of 89%
with a chronic lung diagnosis
for three months and one of the
following: Cor Pulmonale, CHF
or Erythrocythemia. Patients must
be re-tested during the 61st to
90th day of therapy to receive
on-going coverage.
- Other needed information: Where
the tests are performed, the prescribed
liter flow and hours of use, type
of O2 system requested (if portable
oxygen is needed, patient must
be ambulatory within the home
to be covered).
- PO2 or SaO2 results above the
levels listed will NOT be covered.
- Testing must be completed within
48 hours prior to dismissal from
hospital or by independent out
patient laboratory.
 Portable
Compressed Gas Unit
This is a portable
compressed gas system, that includes
a regulator (to control the rate or
flow of oxygen), cylinder and cart
or carrying case.
Medicare
- A portable oxygen unit may be covered,
by itself, or in addition to a stationary
oxygen system. However, patient must
meet the test criteria listed for
stationary oxygen systems and must
be ambulatory in the home.
 Suction
Machine
This machine creates
continuous suction at various pressure
settings. It is used with disposable
catheters to remove secretions in
patients with a compromised cough
mechanism or tracheotomy.
Medicare
- Rental only. Capped rental.
Patients must have ONE OR MORE
of the following indications:
- Difficulty raising and clearing
secretions.
- Cancer or surgery of the
throat.
- Dysfunction of the swallowing
muscles.
- Unconscious or semi conscious
state.
- Has a tracheostomy.
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