Respiratory Assist Devices
Respiratory Assist Devices are a more complex device that CPAP. CPAP is continuous pressure being blown into your airway, some patients and conditions can't tolerate that and need devices that recognize your breathing patterns and reduce pressure when you are trying to breathe out (actually, some devices monitor much more than that, but let's not get more complex than you need). These are called Respiratory Assist Devices and you may know some of them as Bi-pap, APAP or VPAP.
Effective January 1, 2006, patients must be characterized under one of the following clinical disorder groups in order to qualify for a RAD:
- COPD,
- restrictive thoracic disorders,
- central sleep apnea (CSA) {on a side note, if you've been diagnosed with Complex Sleep Apnea, this comes under a form of CSA), or
- OSA
If your primary diagnosis is OSA, then you may qualify for a RAD if you met the criteria described above:
- apnea hypopnea index (AHI) is > 15 events per hour OR,
- AHI is from 5 to 14 events per hour with documented symptoms of:
- excessive daytime sleepiness, impaired cognition, mood disorders, or insomnia, OR
- hypertension, ischemic heart disease, or history of stroke AND
- a single-level device (CPAP) has been tried and proven ineffective.
If you primary diagnosis is CSA, then you may qualify for a RAD if you meet the criteria of a complete facility-based, attended PSG and demonstrate all of the following:
- diagnosis of CSA
- an apnea index > 5
- central apneas/hypopneas > 50% of the total central apneas/hypopneas
- central apneas/hypopneas > 5 times per hour
- symptoms of either excessive sleepiness or disrupted sleep
- exclusion of OSA as the predominant cause of sleep-associated hypoventilation and the elimination of CPAP as effective therapy if OSA is a component of the sleep-associated hypoventilation
- significant improvement of the sleep-associated hypoventilation with the use a RAD device while breathing the patient's usual FiO2.
FiO2 is the percentage of oxygen in the air inhaled, either on or off the ventilator. FiO2 ranges are from 21% (eg in room air) to 100% (eg pure oxygen).
For COPD and restrictive thoracic disorders tests also have to show a certain level of desaturation < 88% for at least 5 minutes.
Three months after starting your therapy, both your physician and you will be required to respond to questions in writing regarding your continued use along with how well the machine is treating the condition.
Medicare covers the use of the RAD for up to 3 months. If a patient requires the RAD beyond 3 months, no sooner than the 61st day after beginning use of the RAD, the supplier must be notified by the doctor or the patient that there will be continued use beyond the three-month period. Medicare covers accessories used with the RAD if the RAD is covered by Medicare: masks; cannulas; tubing and other necessary supplies.
An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor.
RADs are in the Capped Rental category of DME; that means you may choose to rent or purchase a RAD.
