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Will Medicare cover an oral appliance if the patient has a CPAP machine that they're currently paying for?
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi sjbdds!
Great question. The short answer is yes -
the longer answer is: yes, as long as the patient maintains the medicare required compliance guidelines with the CPAP machine to get the continued coverage, and as long as the coverage criteria for an oral appliance to establish medical necessity are met!
Some patients may be recommended for "combination therapy" where the oral appliance & PAP machine are used in conjunction with each other - with the hopes of being able to lower the PAP pressure to a tolerable level for the patient, Some patients may need the oral appliance to supplement certain times they are unable to use their PAP machine,etc etc.
So - it's just important to keep in mind:
-what is the insurer's criteria for maintaining coverage of the PAP machine?
-Will the patient still be able to maintain their minimum compliance requirements while utilizing the oral appliance as well?
-Is the oral appliance being used for combination therapy with a PAP machine?
Hope this helps! Please feel free to contact us with any further questions.
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