Reimbursement Criteria And Issues

Financial constraints may limit the use of APAP devices for chronic treatment of OSA at least in some circumstances. In the United States durable medical equipment (DME) providers receive the same reimbursement for supplying an APAP device as a CPAP device despite the greater cost of APAP. One option is to pass the extra cost to the patient who often pays out of pocket for the difference. Some patients may choose to buy a unit directly from a national discount provider over the Internet.

Unattended auto-titration is currently not reimbursed in the United States. For this reason, it has been most widely used in circumstances where reimbursement for the auto-titration is not an issue such as certain health maintenance organizations and the Veterans Health Care System. In the private sector, some DME providers are willing to provide an APAP loaner for a few days to weeks to determine a fixed CPAP pressure (if a CPAP will be provided by them at a pressure based on the study). In this setting, the patient is responsible for paying for the mask and other supplies should they decline CPAP treatment.

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