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Apnea Monitors

Date: 03-08-2012

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Covered Services
  • Noncovered Services
  • Authorization
  • Billing
  • Overview

    Apnea monitors are used to monitor breathing and cardiac status for children at risk of apnea or sudden infant death syndrome.

    Eligible Providers

  • • Medical suppliers
  • • Hospitals
  • • Indian Health Services
  • • Federally Qualified Health Center
  • • Rural Health Clinic
  • TPL and Medicare

    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.

    Eligible Recipients

    Apnea monitors are covered for all eligible MHCP recipients.

    Covered Services

    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:

  • • Apparent Life Threatening Episode(s) (ALTE)
  • • Apnea (central or obstructive)
  • • Choking or gagging
  • • Skin color change (cyanosis, pallor, erythematous or plethoric)
  • • Marked change in muscle tone
  • • Tracheotomies or anatomical abnormalities that make them vulnerable to airway compromise
  • • Metabolic or neurologic disorders affecting respiratory control
  • • Chronic lung disease, especially those requiring mechanical ventilation, positive airway pressure or supplemental oxygen
  • • Premature infants with delayed maturation of respiratory control
  • • Apnea of prematurity
  • • Preterm infant with bradycardia and/or desaturation
  • • Diagnosed pertussis
  • • Apnea monitors are covered for infants with siblings who died of Sudden Infant Death Syndrome (SIDS)
  • • An apnea monitor with recording feature are considered medically necessary with documentation of unusual symptoms or reporting of alarms that cause the physician to request additional information.
  • Noncovered Services

    Apnea monitors are not covered as an alternative to polysomnography for diagnosis of obstructive sleep apnea or other conditions.

    Authorization

    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.

    Billing

    Refer to the Billing and Documentation section on the main Equipment & Supplies page for information on how to bill.

    Included with rental or purchase of all apnea monitors:

  • • Batteries
  • • Battery charger
  • • Carrying case
  • • Cords
  • • Connecting cable
  • • Data collection /information transfer media and supplies
  • • Electrical cords
  • • Printed instructions
  • Separately bill:

  • • Electrodes
  • • Lead wires
  • • Rib belt
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