Local Coverage Determination · DME MAC
L33718
Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
Version 52. CMS effective date 01/01/2024. CMS updated 12/07/2023. Read from the CMS Coverage API on 2026-10-13. Contractors on the report: CGS Administrators (DME MAC) and Noridian Healthcare Solutions (DME MAC).
CMS coverage policy citation. CMS Pub. 100.03 (Medicare National Coverage Determination Manual), Chapter 1, Section 240.4
Coverage indication
In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement: The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section. The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section. Refer to the Supplier Manual for additional information on documentation requirements. Refer to the DME MAC web sites for additional bulletin articles and other publications related to this LCD. For the items addressed in this LCD, the “reasonable and necessary” criteria, based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity. Apnea is defined as the cessation of airflow for at least 10 seconds. Hypopnea is defined as an abnormal respiratory event lasting at least 10 seconds 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 saturation. The apnea-hypopnea index (AHI) is defined as the average number of episodes of apnea and hypopnea per hour of sleep without the use of a positive airway pressure device. For purposes of this policy, respiratory effort related arousals (RERAs) are not included in the calculation of the AHI.
Excerpt from the LCD indication. Full text on CMS.
Documentation requirements
Items covered in this LCD have additional policy-specific requirements that must be met prior to Medicare reimbursement. Refer to the LCD-related Policy article, located at the bottom of this policy under the Related Local Coverage Documents section for additional information.
Related articles
- A52467 · Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea - Policy Article
- A55426 · Standard Documentation Requirements for All Claims Submitted to DME MACs
- A58824 · Response to Comments: Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea – DL33718
Related NCDs
- NCD 240.4 · Continuous Positive Airway Pressure (CPAP) Therapy For Obstructive Sleep Apnea (OSA) (version 3)
- NCD 280.1 · Durable Medical Equipment Reference List (version 4)
HCPCS codes on this LCD
18 other Level II codes are on the LCD and are not given a page in this set: E0471, A7028, A7029, A7030, A7031, A7032, A7033, A7034, A7035, A7036, A7037, A7038, A7039, A7044, A7045, A7046, E0561, E0562.
Questions
What does LCD L33718 cover?
L33718 is Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea. It is a current final DME MAC local coverage determination, version 52.
Where is the CMS source for L33718?
The Medicare Coverage Database page for LCD L33718 version 52.
Get the signed answer via API
The signed answer is the receipt for this code on a date of service: the rule that was in force, with a hash you can replay. The call needs an API key. The source archive and as-of resolution are public.
curl -H "X-API-Key: $VERZI_API_KEY" \
"https://api.verzi.health/v1/rules/warrant?hcpcs=E0470&as_of=2024-01-15&npi=1234567890&state=UT"