Program Memorandum

Carriers

Department of Health & Human Services (DHHS) 

Centers for Medicare & Medicaid Services (CMS) 

Transmittal B-02-035 
 
Date: MAY 17, 2002 

CHANGE REQUEST 2165 

SUBJECT: Elimination of Certificate of Medical Necessity (CMN) Requirement for Continuous Positive Airway Pressure (CPAP) Device - Clarification 

Scope 
   This is a clarification to Program Memorandum (PM) B-02-022, Change Request 2076. 

Background 
   A recent National Coverage Decision in the Coverage Issues Manual §60-17 now allows use of an 
apnea-hypopnea index (AHI) for the diagnosis of obstructive sleep apnea. This revised National 
Policy is effective for dates of service on or after April 1, 2002. The revised DMERC policy 
provides instructions for continued coverage of the device beyond the first 3 months and provides 
coverage for heated humidifiers used with a CPAP device. The additional provisions of the DMERC 
policy are effective for dates of service on or after July 1, 2002. A major change in the revised 
policy is the elimination of the CPAP CMN. The CPAP CMN is not required for initial claims with 
dates of service on or after April 1, 2002. Instead of a CMN, the supplier must use a KX modifier to 
indicate that the coverage and payment rules have been met. However, since the KX modifier is not 
valid until July 1, 2002, the effective date of the DMERC policy is July 1, 2002. 

Implementation 
   The code E0601 (CPAP device) needs to be removed from CWF category 59 (CMN required). 

The effective date for this PM is April 1, 2002. 

The implementation date for this PM is July 1, 2002. 

These instructions should be implemented within your current operating budget. 

This PM may be discarded after July 1, 2003. 

If you have any questions, contact Angie Costello at (410) 786-1554 or acostello@cms.gov. 

CMS-Pub. 60B