Required PAP Therapy Information
How is obstructive sleep apnea
OSA must be diagnosed by an attended, facility based polysomnogram,
and the patient must meet one of the following Apnea-Hypopnea Index
1. AHI >– 15 events per hour
2. AHI from 5 to 14 events per hour with documented symptoms of: A)
excessive daytime sleepiness, impaired cognition, mood disorders or
insomnia; or B) documented hypertension, ischemic heart disease or
history of stroke.
What is Medicare’s definition of AHI?
The AHI is defined as the average number of episodes of apnea and
hypopnea per hour, and must be based on a minimum of two hours of
recording time without the use of a positive airway pressure device,
reported by polysomnogram.
Apnea is defined as the cessation of airflow for at least 10 seconds
as documented on a polysomnogram. Hypopnea is defined as an abnormal
respiratory event lasting at least 10 seconds and associated with at
least a 30% reduction in thoracoabdominal movement or airflow as
compared to baseline, and with at least a 4% decrease in oxygen
CPAP and BiPAP systems and supplies can only be dispensed with a
prescription. Maier Family Pharmacy requires a copy of the
patient's split sleep study for all new CPAP orders. The sleep
study is also needed for ongoing billing of patient supplies like
masks, tubing and filters. CPAP prescriptions are generally written
by the patient's physician after a recommendation from a certified
sleep lab therapist or technician. If a patient is requiring a new
mask, tubing or filters, please write a prescription for Mask and
Please fax all sleep study information along with a
prescription to: 712-881-1206.
Note: In most cases, CPAP setups require 2-4 days to verify
insurance coverage, configure equipment, and order the correct mask
for the patient. The patient will be contacted for a setup time and
date from our respiratory therapist.
Maier Family Pharmacy does not perform sleep studies.
Physicians or patients can order sleep studies through the area
hospital sleep labs or by an independent firm. Qualifying
information must include the AHI#