What are the Medicare Sleep Apnea Guidelines?

Posted By EightNine On 24th April 2011

It can be tricky to diagnose sleep apnea. The problem is that most of the symptoms occur while you are sleeping. Therefore the only way to get an accurate diagnosis would be for your doctor to watch you sleep. This is hardly practical in most cases. The medicare sleep apnea guidelines were created as an attempt to solve this problem by creating criteria to determine just when a sleep test would be needed.

The medicare sleep apnea guidelines revolve mainly around how the condition is to be diagnosed and which treatments they are going to pay for. Over the last few years there has been quite a bit of controversy over this in particular when it came to continuous positive airway pressure treatments or CPAP. This is one of the most effective treatments that there is for sleep apnea, it works by having the patient wear a mask while they sleep so that air can be forced into their breathing passages. While nobody questioned the value of CPAP it was very hard to get medicare to pay for it.

The issue with getting CPAP in the past was that the medicare sleep apnea guidelines required that to qualify the patient needed a clear diagnosis, which could only be done with a sleep study at a sleep clinic. The problem is that it is both expensive and impractical to give everybody who might have sleep apnea a sleep test. Therefore doctors were required to go through a series of other tests in order for patients to qualify for the sleep test. The end result was that a lot of patients who actually had sleep apnea were unable to get the treatment that they needed.

Recently the medicare sleep apnea guidelines have been changed in order to address this problem. The new guidelines now allow for a home sleep test to be sufficient to qualify for a diagnosis of sleep apnea. In this test you will borrow the required equipment from your doctor, take it home and wear it while you sleep and then return it so your doctor can interpret the results. This makes it much easier to diagnose sleep apnea since it is no longer necessary to find a space for the patient at a sleep clinic. Therefore more people are able to get the treatment they need.

While the new medicare sleep apnea guidelines have certainly been helpful they have not been completely successful. It still requires a number of tests from your doctor before you are even able to take the sleep test and all of these tests plus the sleep test need to be documented. The issue now is that it creates a lot of work for your doctor for which he really doesn’t receive a lot of payment. Therefore a lot of doctors are not administering the required tests. You may have to look around to find a doctor willing to do all of the tests to qualify you for the medicare sleep apnea guidelines.

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