Apnea monitors are used to monitor breathing and cardiac status for children at risk of apnea or sudden infant death syndrome.
Providers must meet any provider criteria, including accreditation, for third party insurance or for Medicare in order to assist recipients for whom MHCP is not the primary payer.
MHCP quantity limits and thresholds apply to all recipients unless only Medicare co-insurance or deductible is requested.
Apnea monitors are covered for all eligible MHCP recipients.
Codes: A4556 (electrodes), A4557 (lead wires), E0618 (apnea monitor), E0619 (apnea monitor with recording feature)
Document medical necessity in the recipient’s file at the medical supplier’s office. Providers should verify continued need for the equipment every three months. Apnea monitors are covered as capped rental items, no more than 13 months rental will be paid.
Apnea monitors are considered medically necessary for recipients under age 2 with any of the following risk factors or similar medical conditions:
Apnea monitors are not covered as an alternative to polysomnography for diagnosis of obstructive sleep apnea or other conditions.
Authorization is required only for maintenance service and repairs to recipient-owned equipment.
Refer to Non-Mobility Equipment Repairs for authorization requirements for repairs and maintenance service.
Refer to the Billing and Documentation section on the main Equipment and Supplies page for information on how to bill.
Included with rental or purchase of all apnea monitors: