Medicare PAP Use Outpacing Other DME

Number of beneficiaries using sleep devices up 13%, allowed charges up 23% from 2012 to 2013.

Usage of PAP devices and products among Medicare beneficiaries is on the rise, while other DME items are actually down, according to data generated for a comparative report commissioned by CMS.

The comparative report, CBR201401 Positive Airway Pressure (PAP), notes that while the number of beneficiaries receiving DMEPOS of all type decreased by 1 percent between July 2012 and June 2013, the number of beneficiaries receiving PAP products increased 13 percent while.

The analysis, which was developed and conducted by eGlobalTech and Palmetto GBA, also showed that allowed charges for PAP products grew by 23 percent, while allowed charges for all DMEPOS items actually declined by 2 percent. 

Other key changes in allowed charges during the July 2012-to-June 2013 period:

  • Filters were up 37 percent.
  • Humidifiers were up 12 percent.
  • Masks were up 21 percent.
  • PAP Devices were up 13 percent
  • Tubing was up 27 percent.

A statistical briefing of the study can be found at

The report analyzed data from claims processed by the four DME MACs between July 2012 and June 2013 to come up with the data points. CMS commissioned the study because proper billing of PAP devices and related items was identified as an area of risk in the Medicare program.

The goal was to create a comparative report that would serve as an educational tool to show DME providers how their claims compare to state and national averages. The comparison covers allowed charges for PAP devices and accessories; number of PAP devices and accessories per beneficiary; use of more expensive PAP devices and accessories. The comparison also outlines the various LCDs and guidelines applying to their claims.

A sample of such a comparitive reportcan be found at

About the Author

David Kopf is the Executive Editor of HME Business and DME Pharmacy magazine. Follow him on Twitter at @postacutenews.


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