CMS has announced that Medicare will no longer require medical necessity for claims on replacement accessories used with beneficiary-owned continuous positive airway pressure (CPAP) devices or a respiratory assist devices (RAD).
Published in an alert at http://go.cms.gov/2b9ZcX0, the new policy says that for the purposes of processing claims, the medical necessity for the base CPAP device or RAD is assumed to have been established following 13 months of continuous use.
Also, CMS’s alert notes This policy doesn’t apply to replacement accessories for a CPAP or RAD that has been continuously used for less than 13 months, or for accessories on a device wasn’t purchased by Medicare. In those cases, all documentation for the CPAP’s or RAD’s medical necessity must be furnished. Similarly, in the event that certain accessories are furnished for the first time, such as a heated humidifier or heated tubing, CMS will ensure that the accessories are medically necessary.
A statement from the American Association for Homecare noted that the association had been asking CMS for the policy change since 2014, and that it has asked for further clarification on the exact documentation requirements for replacement supplies.