Is Medicare Coverage Inspiring Treatment for Sleep Apnea? - (2023)

Measurements of plasma and serum tumor necrosis factor alpha levels

New sleep apnea treatment

Imani and co-workers stated that OSAS is associated with a variety of inflammatory factors. In particular, pro-inflammatory cytokines appeared to be associated with the pathogenesis of OSAS. For the present meta-analysis and meta-regression of serum and plasma tumor necrosis factor-alpha levels in individuals with and without OSAS, these investigators performed a systematic, unrestricted search of PubMed/Medline, Scopus, the Cochrane Library, and the Web of Science Databases Identification of relevant articles published up to February 1st, 2020. A total of 55 were included and analyzed. The pooled MDs were always as follows compared to age-matched healthy controls: adults, serum: 10.22 pg/mL adults, plasma: 5.90 pg/mL children, serum: 0.21 pg/mL children, plasma: 5, 90 pg/mL . The authors concluded that adult subjects with OSAS had significantly higher serum/plasma TNF levels compared to healthy and age-matched controls. Significantly higher levels of TNF in serum but not in plasma have been observed in children with OSAS. They noted that the results of this meta-analysis showed that elevated TNF levels in people with OSAS appeared to be related to disease severity. In addition, these researchers indicated that future studies should investigate whether and to what extent interventions in OSAS have a beneficial effect on TNF levels and possibly also on weight regulation.

The Story of Denise H

Denise Hoover discovered the existence of Inspire Therapy the old-fashioned way when she read an article in the newspaper. And it came at a fortunate time.

She was diagnosed with OSA about 20 years ago and underwent surgery to remove her tonsils and uvula. That worked for a while, then I used CPAP and I couldn't take it, then I tried a dental machine and it didn't work. I ran out of options, she says.

Hoover first consulted with Patrick Strollo, MD, FCCP, FAASM, Medical Director of the Sleep Medicine Center at UPMC, about implanting the Inspire device.

Strollo ordered a sleep study that Hoover knew would show she had OSA. She then reached out to Soose, who assessed her CPAP tolerance and verified that she met the BMI criteria. Eventually she underwent a sedated endoscopy which showed she was a good candidate for the procedure she underwent in May 2014.

Soose notes that many of his Inspire patients know these are tough cases. These arent patients expecting to eliminate their OSA. They're more accepting of the side effects of OSA treatment, he says. According to the company's website, there are some possible side effects of the treatment, ranging from a dry mouth or trouble speaking to nerve damage or bleeding.

Inspire the definitive evaluation of sleep apnea therapy

This device is intended for people over the age of 18 who have moderate to severe obstructive sleep apnea.

This device could help stimulate the hypoglossal nerve, which causes the neck and relevant muscles to move, and open the airways to allow the user to breathe better.

Using this device can be simple and only requires the user to turn on the device to have a good sleep and breathe properly.

The device can help monitor the user's breathing patterns throughout the night. In addition, the device may be able to adjust stimulation throughout the night as needed.

After the device insertion procedure, the user can return to their normal daily routine and continue to follow a normal diet the day after the procedure.

Proper function and recovery may be required the night after the procedure is complete.

This device requires little maintenance and is also easy to use. However, the initial cost of the device and payment for the installation process is high. If you're looking for a budget-friendly alternative, consider other sleep aids such asPeptiva-Probiotika,Dream Water sleep aid, AndFormula 303.

With such facts, you can finally make the final decision whether you should use it or not.

For more information on Inspire sleep apnea therapy, click hereOfficial site.

Below are what we believe to be some of the most effective natural sleep aid formulations available on the market today.

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Diagnosing sleep apnea in children

Most physicians follow these guidelines from the American Academy of Pediatrics:footnote 4

  • During a routine check-up, your doctor will ask you and your child about snoring. If your child snores, be sure to tell your doctor.
  • A full sleep study is usually required to find out if your child has sleep apnea and isn't just snoring.
  • Children with sleep apnea and other conditions such as Down syndrome or sickle cell anemia may need to see a specialist.

Repeat the indications for the sleep study

Is Medicare Coverage Inspiring Treatment for Sleep Apnea? - (1)

It may be necessary to conduct repeat sleep studies up to twice a yearanythe following indications. conducted in a healthcare facility are considered medically necessary for individuals who meet the criteria for attended NPSG in Section I above, unsupervised sleep studies are considered medically necessary in all other cases):

  • To determine whether positive airway pressure treatment (demand positive airway pressure, variable positive airway pressure, or automatically titrating positive airway pressure) remains effective in individuals with new or ongoing symptoms, after interrogating the current positive airway pressure deviceor
  • To determine if positive airway pressure treatment settings need to be changed for individuals with new or ongoing symptoms, after querying the current positive airway pressure device.or
  • In individuals with significant weight loss or other change in their medical condition that would affect the need for continued positive airway pressure treatment to determine whether continued positive airway pressure treatment is requiredor
  • Evaluation of treatment response after upper airway surgery and after initial treatment with oral appliances.

    note: A home sleep study conducted over multiple nights with a single interpretation qualifies as a single sleep study for reimbursement purposes.

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    National cms coverage policy

    Title XVIII of the Social Security Act, Section 1862 permits coverage and payment only for those services considered appropriate and necessary for the diagnosis or treatment of disease or injury, or to improve the functioning of a deformed limb.

    Title XVIII of the Social Insurance Act, Section 1862 Articles and services related to research and experimentation.

    Title XVIII of the Social Security Act, Section 1862 states that Medicare does not cover services or procedures involving routine physical examinations.

    CMS-Nur-Internet-Handbuch, Pub 100-02, Medicare Benefit Policy Manual,Chapter 15, §60.1 Physician Professional Services Incident, §110 Durable Medical Devices in general

    CMS web manual only, Pub 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §160.7 Electrical Nerve Stimulators Chapter 1, Part 4, §240.4 Continuous Positive Airway Pressure Therapy For Obstructive Sleep Apnea Chapter 1, Part 4 , §240.4.1 Sleep testing for obstructive sleep apnea

    Inspire surgery for sleep apnea

    Inspire sleep apnea surgery is the latest treatment for sleep apnea and an effective alternative to CPAP. Neurosurgery One now offers Inspire, the only FDA-cleared deviceobstructive sleep apneaTreatments that work inside your body to treat the root cause of sleep apnea in just one click. Inspire is an implanted device that works while you sleep by sending a gentle, imperceptible stimulation to keep your airway open.

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    Appeal denying health insurance coverage for a sleep study or treatment for a sleep disorder

    A current storyNPR Newsreported thathalf of all patients win their appeals against health insurance rejections. They told the story of a patient with drowsiness and loud snoring who saw a doctor who recommended a sleep study. The insurance company refused to authorize the sleep study. The patient appealed which overturned the decision and now the patient is being treated for sleep apnea and is feeling much better. The story reported findings from a 2011 report by the General Accounting Office that showed successful appeals 40-60% of the time, while another California study had similar results with about 50% success.

    Benefits of Inspire sleep therapy

    Sleep Apnea Treatment CPAP Alternative: Oral Device Therapy by Dr. Bruce A Kanehl


    The Inspire implantable device does not interfere with your daily life, such as B. Exercise, work and food, and you have no way of extending any eccentric developments to your own eating regime either. Aside from being small, it's also implanted in your body and easily controlled with a small handheld remote, meaning you don't need all that extra space for a bulky CPAP machine or having to put it away in the morning when you wake up.


    During the first year of implanting your Inspire Sleep device, your doctor will want to see you regularly every few months. However, once you have made sure that the device is working properly and that there are no side effects, you must undergo an annual check-up.

    The battery of the Inspire Sleep device lasts about 10 years, after which your remote control will show you that the battery is low. You need to see your doctor to replace the battery, which is a quick and easy process.

    The battery in your remote control is a standard 9 volt battery that is easily replaceable.

    Easy to use

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    How was the upper airway stimulation cost study conducted?

    This study was designed to provide a general estimate of the cost and effectiveness of upper airway stimulation. We used established methods of profitability analysis. Direct healthcare costs totaled nearly $43,000. These were the Medicare payment amounts for healthcare costs such as the surgical implantation procedure and additional sleep studies and doctor visits, minus the cost savings for reducing potential sleep apnea complications. To be cautious, we have not considered financial benefits that may come with sleep apnea treatment, such as: B. improved labor productivity that can occur with sleep apnea treatment.

    The efficacy assessment was based on thePublication of the STAR study, in which 66% of patients who received the device experienced dramatic improvement or resolution of their sleep apnea. Study data were used to estimate reductions in side effects based on published studies of other sleep apnea treatments. These results were combined to show that upper airway stimulation delivers 1.09 QALYs over a person's lifetime.

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    Are there any side effects of the Inspire treatment?

    Sudden surgery in the throat can cause mild problems for some time, but nothing serious. Surgeons know patients who are concerned about follow-up care.

    However, there can be two serious side effects that patients will notice after Inspire treatment.

    • The first is slight swelling at the incision site, which is a fairly common problem after any surgery.
    • The second is the slight pain or soreness on the tongue for a while. Both of these pains will decrease over time.

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    How much do I have to pay for this procedure out of pocket?

    Every insurance plan is different. In general, co-payment costs for Inspire Therapy should be consistent with co-payments for other outpatient surgical procedures. Some patients may have secondary benefits or supplemental insurance that will offset their co-payment. Your Inspire therapy team will support you through this process.

    Patients receiving an Inspire experiencesignificant cutsin sleep apnea events and significant improvements in quality of life and daytime functioning. Contact the team of experts atComprehensive sleep centerto find out if Inspire sleep apnea therapy is right for you.

    Sleep apnea and snoring advice

    Is Medicare Coverage Inspiring Treatment for Sleep Apnea? - (2)

    dr Tucker is so convinced that knowledge and action can improve and save lives that he offers a free, personalized, 30-minute sleep breathing consultation. Whether it's loud snoring or other sleep apnea symptoms, make sure you don't put yourself at risk for this highly treatable, potentially life-threatening condition. Learn more about sleep apnea and get answers to all your questions. We have a limited number of consultation times available, so arrange yours as soon as possible.

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    What to think about

    If you're considering surgery to treat sleep apnea, talk to your doctor about surgerysleep studyfirst done.

    Experts usually suggest you try itcontinuous positive airway pressurebefore considering surgery.

    In laser-assisted uvulopalatoplasty, a laser is used to perform the surgery. It's sometimes used to treat mild to moderate sleep apnea, although not all people benefit from it. This surgery is not recommended by the American Academy of Sleep Medicine to treat sleep apnea.footnote 16

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    Medicare guidelines for Cpap

  • There is a three-month trial period for CPAP therapy.
  • Medicare will continue to cover your CPAP machine after the first three months if your doctor confirms that the CPAP therapy is helping.
  • Medicare pays the CPAP provider a rental fee for 13 months of uninterrupted use. After that, the machine is yours.
  • If you had a CPAP machine before you enrolled in Medicare, you may be covered for the rental of a replacement machine or accessory.

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    Anthem Blue Cross Sleep Apnea Cover

    Find doctors treating Obstructive Sleep Apnea near Beavercreek, OH

    Devices are covered long-life medical devices for Anthem Medicare. Advantage. Anthem. The DME MAC Local Coverage Determination for your area addresses the coverage criteria for. that the symptoms of obstructive sleep apnea are improved and objective evidence of compliance with the use of the.

    Apnea Hypopnea Index Sleep apneaPositive Airway Pressure Devices Positive airway pressure devices, used with a variety of breathing masks, are the most widely used treatment for moderate and severe airway conditions. Sleep Apnea Index Chart Sleep Apnea Index Chart | Find the Sleep Apnea Index Table. Investigate now. Study objectives: In patients with severe obstructive sleep apnea syndrome (

    Find Anthem coverage. Investigate now.

    As sleep apneaCentral Sleep Apnea ALS/MND Support Group Forums Hi everyone. I'm wondering if anyone has experience with central sleep apnea. For the people who may not know my story a few months ago i Disorders. All glitches. NINDS Binswangers Disease Information Page NINDS Brachial Plexus Injuries Information Page NINDS. Even if you

    Pre-existing conditions: Pregnancy, sleep apnea can cause you to pay moreThree of the largest insurers in the US, United Healthcare, Cigna, and Anthem Blue Cross Blue Shield, generally considered an individual uninsurable and could refuse coverage without reviewing medical records if an applicant had one.

    Find Anthem Blue Cross cover. Investigate now.

    How does Inspire Surgery For Sleep Apnea work?

    Inspire device designed to stop sleep apnea and improve your sleep

    Inspire Surgery is the latest treatment forsleep apneaIt works while you sleep to keep your airway open so you and your partner can sleep soundly and peacefully.

    Inspire is a small device that is inserted through tiny incisions in your upper chest during a same-day outpatient procedure. You come back 30 days later to have it programmed and you're done.

    Every night you just click the little remote control to turn on Inspire. Then, while you sleep peacefully, Inspire delivers mild, unnoticeable stimulation to keep your airways open so you can breathe normally and wake up refreshed.

    You turn off the Inspire stimulator when you wake up. That's it. No mask, no hose, no noisy breathing apparatus. just sleep

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    How does Inspire Therapy feel?

    The nerve stimulation of Inspire Therapy is not uncomfortable. Patients report a slight tingling or contraction of the tongue. The stimulation level is adjustable and will be adapted to you and your response to the treatment. The stimulation provided by the system is controlled with a remote control and can be turned on and off as needed. The treatment is to simply activate the device at bedtime and then turn it off when you wake up.

    This is a requirement to inspire

    If the patient then elects to continue Inspire Therapy, Inspire Therapy coverage for sleep apnea requires adrug-induced sleep endoscopyto assess the configuration of the soft palate collapse. Concentric collapse at the level of thevelopharynxis considered a contraindication. The procedure goes something like this: The doctor places the patient in an outpatient treatment room and initiates sleep. The doctor can then perform flexible laryngoscopy by inserting a flexible endoscope up the patient's nose and down the throat to view the velopharynx while the patient sleeps. This DISE procedure is billed to the insurance company using CPT® code 31575Laryngoscopy, flexible diagnostics. Although the physician time allocated to a DISE patient is significant as an outpatient procedure, reimbursement is low. Physicians must view DISE as part of the larger Inspire treatment package.

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    How much does the Inspire implant cost?

    "A patient's financial responsibility varies based on the specifics of their individual insurance plan," Inspire told CNET. "In general, most patients only have to pay the applicable deductibles and co-payments that exist for their insurance plan."

    According to Inspire's website, it's covered bymostinsurance provider. Exact deductible costs depend on your insurance plan. Keep in mind that this is an outpatient procedure, so there are some medical bills to consider.

    However, as an example, the pricing page states that a person on traditional Medicare should expect to pay a maximum of $1,400 out of pocket if the procedure is performed in the hospital.

    You can expect a total bill of approximately$30,000 to $40,000both for the operation and for the equipment cost, but that isBeforeYour insurance applies. I can't say exactly how much you'll end up paying - it depends a lot on your insurance plan and deductible. If you're interested in Inspire, it's best to speak to your provider to discuss your options.

  • FAQs

    Is inspire implant for sleep apnea covered by Medicare? ›

    Is Inspire Covered by Medical Insurance? Most major U.S. insurance providers, including Medicare, cover Inspire. Some Veterans Affairs and military hospitals also cover treatment.

    How do you qualify for inspiration for sleep apnea? ›

    You are eligible for Inspire Sleep Surgery if:

    You have moderate to severe OSA with a diagnostic sleep study in the past 2 years. You tried CPAP therapy and it didn't work. You do not have significant trouble falling asleep. You have a body mass index (BMI) of 32-35 or less.

    Who Cannot use Inspire for sleep apnea? ›

    For example, Inspire therapy is not intended for patients with a complete concentric collapse at the level of the soft palate, or those in whom central and mixed apneas make up 25% or more of their apnea-hypopnea index. Patients who require MRI should discuss Inspire therapy with their doctor.

    Who is not a candidate for inspire? ›

    Contraindications for the use of Inspire UAS therapy include the following: Central + mixed apneas >25% of the total apnea-hypopnea index (AHI) Any anatomical finding that would compromise the performance of upper airway stimulation, such as the presence of complete concentric collapse of the soft palate.

    Is inspire better than a CPAP machine? ›

    The benefits of the Inspire implant are significant -- better sleep quality, no more daytime fatigue and a lowered risk for a stroke or heart attack. Per the FDA, the "probable benefits outweigh the probable risks" for approved obstructive sleep apnea patients who aren't benefitting from traditional CPAP therapy.

    How much is inspire sleep apnea implant? ›

    According to a 2020 review article, the procedure costs about $30,000. Your health insurance provider may cover some or all of the costs. With regular use, the battery of the device will last about 11 years .

    What are the drawbacks of inspire? ›

    The Cons. Since Inspire is a surgery, it comes with the risks that any surgical procedure involves. This means that though Inspire is simple to use after surgery, it is more invasive than a CPAP machine. Additionally, any time a foreign object is implanted in the body, it carries some risk of infection.

    How does inspire work instead of CPAP? ›

    How does the Inspire sleep apnea device work? Based on your unique breathing patterns, the Inspire system delivers mild stimulation to the hypoglossal nerve, which controls the movement of your tongue and other key airway muscles. By stimulating these muscles, the airway remains open during sleep.

    How long does inspire sleep apnea last? ›

    Through a simple, outpatient surgical procedure, the Inspire therapy system is implanted under the skin of the neck and chest via three small incisions. The Inspire battery is non-rechargeable but is designed to last for around 11 years. Once it runs out, it must be replaced as with any other implanted device.

    Can you have an MRI if you have an Inspire device? ›

    Inspire Medical Systems, Inc. announced that the US FDA has approved additional MRI scan conditions for use with Inspire therapy. This full-body MRI approval expands the Inspire use labeling that previously allowed only head, neck, and extremity MRI scans.

    Is inspire surgery painful? ›

    Pain after the procedure varies but for most patients is not severe. Pain will usually resolve within 7-14 days after the procedure and pain medication will be provided. Three incisions will be made: one at the upper neck, one just below the collar bone and a third lower down on the chest under the armpit.

    How many inspire devices have been implanted? ›

    The Inspire system was approved by the FDA in 2014. At this point in time over 1600 patients have been implanted in the United States. The device is implanted in an outpatient procedure.

    How Much Does Medicare pay for sleep apnea machine? ›

    How much does a CPAP machine cost with Medicare? You will pay a 20 percent coinsurance based on the Medicare-approved amount for a CPAP machine. Medicare Part B covers the other 80 percent of the cost. The Part B deductible applies.

    Does Medicare pay for sleep apnea devices? ›

    for the machine rental and purchase of related supplies (like masks and tubing). Medicare pays the supplier to rent a CPAP machine for 13 months if you've been using it without interruption. After Medicare makes rental payments for 13 continuous months, you'll own the machine.

    How long does inspire implant last? ›

    Through a simple, outpatient surgical procedure, the Inspire therapy system is implanted under the skin of the neck and chest via three small incisions. The Inspire battery is non-rechargeable but is designed to last for around 11 years. Once it runs out, it must be replaced as with any other implanted device.

    How long does a Inspire sleep apnea device last? ›

    The battery life on the Inspire device is roughly 10 years. When the battery is low, there will be indicators on your remote to let you know to come in to see your physician. The battery change will require a minor procedure, which can be performed under local anesthesia (or sedation).


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