Does Medicare Require Annual CPAP Dr. Visit?

I am on Medicare and I found a new DME provider but he tells me that in order to buy a mask Medicare now requires that I to go to my doctor every year and have a new prescription from my doctor every year for the mask. Is this so?

In the past once I got a valid prescription from my doctor for a mask I could continue buying that same mask under Medicare for several years, since the mask has been the same one for years. The last time I was at my CPAP doctor was about 2 years ago and I have used the same mask for about 5 years, which works well for me.

The second question is, do you know if my general practice doctor can write a prescription for the mask, or whether it must be the CPAP doctor? Thanks!

No, Medicare doesn't require it but often DMEs or even doctors will say Medicare requires it because they have set up their own inhouse rules requiring it. They can do that but I think they need to be honest about it and not blame it on Medicare.

Yes...your PCP can write the RX for anything cpap related if he will just do it.
Anyone who can legally write prescriptions can do it....dentist, NP, PA, vet, specialist doctor, general practice doctor...etc.

Often the only thing needed is a statement from your doctor that you continue to use cpap and it's working.
I did this with my PCP just at my last visit (blood pressure visit) and told her if she gets a request for something regarding cpap...yes, I am still using it and yes it still works...and no, I don't need to come in.

A kind of related question. The PCP or other type of doc may write a prescription that a patient needs/requires a CPAP and necessary supplies, but who actually prescribes the settings that would go on a machine? I could be wrong, but I don't believe my own PCP would have the knowledge to prescribe the actual settings. I assume it might rely on the prescribing physician to have a copy of the sleep study results that the CPAP settings would be based on which the DME then decides the settings based on the sleep study numbers?

Grumpy48 wrote: ↑

Thu Apr 29, 2021 11:21 am

I could be wrong, but I don't believe my own PCP would have the knowledge to prescribe the actual settings.

Rx: Settings: Patient's Choice ### Mask: Patient's Choice ### Machine: Patient's Choice of APAP

Medicare has required a doctor to state that you regularly use cpap, and benefit from it.
This used to be F2F (face to face), but my last two "visits" with the sleep doc
have been video over the phone.
Medicare covers this call, which probably pays like an office visit.
No surprise that pneumonologists prefer to keep well patients out of the office.
Especially now.

Newbie recent experience:

My dentist was adamant that I have a sleep test. My PCP agreed to do it and did all the paperwork for the request. A week later, I got a sleep test apparatus to use for 2 nights from Blackstone Medical, who created the results report and sent it to my PCP. It was Blackstone that indicated what settings, mask, pressure, tubing, etc I should have and I received all equipment from Apria. Apria set the machine as recommended by Blackstone (air sense 10). If I have a problem, I call Apria and they can change some settings just like I can, on my machine. I had to see PCP after 30, but before 90 days for compliance. I asked who is responsible for reporting compliance to Medicare. My PCP is, but Apria said they can do it too. As long as it’s not me, I don’t care.

I hope I am on topic.

chunkyfrog wrote: ↑

Thu Apr 29, 2021 11:54 am

Medicare has required a doctor to state that you regularly use cpap, and benefit from it.
This used to be F2F (face to face), but my last two "visits" with the sleep doc
have been video over the phone.
Medicare covers this call, which probably pays like an office visit.
No surprise that pneumonologists prefer to keep well patients out of the office.
Especially now.

I got a new cpap about a month ago from the same home care provider that I got my last one from six years ago. What was different this time was the lady at home care said Medicare was monitoring that I used it at least four hours a night in order to pay for it. I still have an app at the sleep clinic every year but was never told it was a requirement.

" . . . the lady at home care . . . "
She does not speak for Medicare, and does not necessarily even KNOW the truth.
Remember, if a DME says it is raining, look outside to know for sure.
As a group, they have taken no oath of truthfulness--as many are known to LIE.

I believe some STATES are requiring a new prescription every year, but I'm not sure which ones.

I found this kind of interesting: https://cpapsupplies.com/no-prescription-required It says:

CPAP Items that DO NOT require a copy of prescription:
CPAP Masks without Headgear: Includes everything except Headgear Straps
CPAP Mask Parts: Cushions, Headgear, Accessories
CPAP Machine Parts: CPAP Hose/Tubing, Filters, Water Chambers, Parts, etc.
Comfort Items: Tube Covers, Moisturizers, Comfort Pads, etc.
A prescription is required for the purchase of all machines, complete mask systems and humidifiers. Each item that requires a prescription is clearly marked on our website. A dated prescription from within the last year is required for PAP machines, and your prescription can be used multiple times within that year. Machines will be set to prescribed pressures as indicated by your prescription prior to shipment.

In other words you can buy a mask as long as a single part (i.e. headgear) is missing and then buy the headgear separately, all without a prescription.

NOTE: This only means you can BUY these things without a prescription. However, you still may require a prescription for these things in order to get it covered by Medicare.

I don't have CPAP coverage under my insurance, so I buy my masks off of our hosts at cpap.com or Amazon. My RX is probably a decade old now at cpap.com and I have no problems, No Rx required with Amazon, no hassle, I get exactly what I want, sometimes the next day.

sleepyguy1 wrote: ↑

Thu Apr 29, 2021 10:12 am

I am on Medicare . . .

First line of the OP's first post . . .
(Shaking my head)

chunkyfrog wrote: ↑

Tue May 04, 2021 5:36 pm

sleepyguy1 wrote: ↑

Thu Apr 29, 2021 10:12 am

I am on Medicare . . .

First line of the OP's first post . . .
(Shaking my head)

I assume this was aimed at me. I can see that the OP IS on Medicare, but I made my point more broadly because people who aren't on Medicare also read these threads. What bug got up your ass??? Shaking MY head.

The TITLE of the thread also contains "Medicare".
Why would non-Medicare clients even look in this thread?
Oh, I forgot--too sensible. . . . That would be haaaard.