Bipap and Medicare

[rmstudier]

Does Medicare require that breathing has deteriorated to some level, 50% fvc for example, before paying for a bipap for als?

 

[abbas child]

Don't know, Randy, but when you go to Clinic, I'd guess the folks there can tell you. Hope you get a "real" answer here soon.

 

[brooksea]

Yes, that is what we were told at clinic. So, if you feel you would benefit from a BiPap, you must breathe as if you are afflicted by a respiratory illness or like your muscles are too weak to pump the lungs. That'll get you qualified (below 50%).

My husband's neuro believes pALS should have BiPaps as soon as possible. I believe it, also.

 

[rose]

There are ways around the 50% FVC (I'm not sure its 50% though,I think it might be 75%) One way for coverage is to submit to a sleep study, and if breathing is bad enough supine or during sleep, a sleep center doctor can write the scrip for bipap using apnea as the cause, rather than ALS. Another way to qualify is for low enough MEP and MIP scores, rather than FVC, & using the ALS diagnosis. Depending on how your clinic handles it, it might involve further testing with a pulmonary doctor, or participating in a sleep study. Its not a bad idea to try for a cause other than ALS for first machine, because then, if you break it (I drowned mine lol, but not actually funny) then you can qualify for a replacement machine using the ALS diagnosis. The way my RT explained it to me (I've not verified if its true, but I trust him) Medicare covers replacement for new masks, etc, every 6 months, but for the machine itself, its every 5 years, unless it is a completely new prescription for condition other than what original machine was ordered for.

 

[michael0314]

That was how I got mine was the sleep study route. I tested barely elegible but got it post ALS diagnosis because of suggestions start asap. Good Luck to you

 

[rmstudier]

Thanks for the input all of you!