1) Must be 18 years or older 2) On the sleep study report, the AHI score must be 15 - 65. 3) On the sleep study report, there must be fewer than 25% central apneas.
- You have moderate to severe obstructive sleep apnea.
- You are unable to use or get consistent benefit from CPAP.
- You are not significantly obese.
- You are age 18 or above.
Who is eligible for inspire sleep surgery?
Feb 02, 2022 · Every insurance plan is different. Generally, the co-pay costs for Inspire therapy should be similar to co-pays for other out-patient surgical procedures. Some patients may have secondary benefits or supplemental coverage that will offset their co-pay. Your Inspire therapy team will help you through this process.
What is the inspire medical systems sleep services billing guide?
An Inspire trained doctor can discuss insurance coverage requirements during an initial consultation. Typically, you can expect to pay any unmet deductible for the year, along with any copay or coinsurance fee for a surgery. 2. Medicare. Medicare is covering Inspire for those who qualify. A doctor trained on the Inspire procedure can discuss ...
Can inspire sleep therapy be used to treat obstructive sleep apnea?
Inspire UAS therapy received PMA approval from the FDA on April 30, 2014. As of April 21, 2020, the FDA has approved an expanded range for Inspire therapy to include 18-21 year old patients. Medicare Coverage Medicare and other payers determine whether to cover the procedure or technology as a health
Is inspire covered by Medicare?
Apr 08, 2022 · The Inspire Sleep Apnea Innovation is the only internal neurostimulation treatment for obstructive sleep apnea currently approved by the Food and Drug Administration. While the initial approval in 2014 was for people at least 22 years old who met the eligibility requirements, the FDA expanded the age range in 2020 to ages 18 and up.
How do you qualify for Inspire?
The eligibility requirements for Inspire stimulation therapy match those of the STAR trial:Age 22 years or older.Moderate to severe OSA (AHI 15 to 65 events/hour)Body mass index (BMI) below 33 kg/m. ... Difficulty accepting or adhering to CPAP.More items...
Who is a candidate for Inspire?
Who is a candidate? Inspire Therapy is not for everyone and patients will have to meet several characteristics: Be 22 years of age or older. Have moderate to severe OSA (AHI range from 15-65 with <25% central/ mixed apneas)
Is inspire implant covered by Medicare?
Is Inspire covered by Medicare? Medicare is reimbursing the cost of Inspire therapy based on medical necessity across the United States.Oct 14, 2020
What is the criteria for Inspire 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?
The Inspire® UAS system should not be used for the following: Types of apnea (central and mixed) other than obstructive are more than 25% of the total AHI. Any physical finding that would compromise the performance of upper airway stimulation, such as the presence of complete blockage of the upper airway.Jun 29, 2020
How long does the Inspire procedure take?
Implantation Procedure: - The procedure to implant Inspire is typically an outpatient procedure lasting about 3 hours. For some special circumstances, your physician may recommend a single night stay in the hospital. - Pain after the procedure varies but for most patients is not severe.
How much does inspire implant cost?
Satisfactory. We learn: “The price tag for the Inspire device is $20,000, with surgery costing extra. Insurance companies are reviewing requests on a case-by-case basis.”May 18, 2017
What is the success rate of Inspire?
Inspire boasts a high success rate. According to research from the STAR clinical trial, 86 percent of those living with someone diagnosed with sleep apnea reported either no snoring or only soft snoring after using Inspire for just 12 months.
How long is recovery from Inspire surgery?
Most patients will return to normal, non-strenuous activity in 1-2 weeks. However, strenuous physical activity increases heart rate and blood pressure, raising the risk of bleeding. In addition, it is important that all components of the Upper Airway Stimulation system heal in place.
Where does inspire get implanted?
The Inspire system is typically implanted during an outpatient procedure under general anesthetic. The system is placed under the skin of the neck and chest through 3 small incisions.
What are the dangers of Inspire?
Side Effects and RisksAllergic reaction or rejection of the implanted materials.Bleeding.Coughing.Damage to the nerve.Difficulty swallowing or speaking.Dry mouth.Headaches.Infection.More items...•Feb 22, 2022
Where is the Inspire device implanted?
The implantation is done under general anesthesia using three small incisions under the chin, below the collar bone and along the side of the chest below the ribs. About four weeks after the implantation, the device will be activated followed by a post-operative sleep study to assure proper stimulation.
Coverage
Most sleep apnea patients who meet eligibility requirements for Inspire have access to insurance coverage. For questions about the policy of a specific health plan, please call or email the Inspire Prior Authorization Hotline.
Support
For questions or support with coding, billing, payer coverage and denied claims, contact the Inspire Reimbursement Hotline.
What is a sleep test?
A sleep testing device that measures seven different channels, including heart rate, air flow, and oxygen levels. Type III: Performed unattended in or out (home sleep test [HST]) of a sleep lab facility or attended in a sleep lab facility.
How much sleep should an older person get?
Most experts recommend older adults get seven to nine hours of sleep per night; however, age-related changes in sleep patterns – including trouble falling or staying asleep – can make it difficult to catch enough Z’s.
Does Medicare cover sleep tests?
Medicare Part B (Medical Insurance) may cover type I, II, III, and IV sleep tests and devices when ordered by a doctor to help diagnose obstructive sleep apnea (OSA) in beneficiaries with clinical signs and symptoms of OSA.
What is a CPAP mask?
Continuous positive airway pressure (CPAP) therapy is a common treatment for obstructive sleep apnea. A mask or nosepiece worn over the face delivers constant and steady air pressure from a machine to help with breathing while asleep.
Does Medicare pay for sleep studies?
Medicare may pay for “medically necessary” testing [such as a multiple sleep latency test (MSLT) or maintenance of wakefulness test (MWT)] that sometimes occur with sleep studies.
What is Medicare approved amount?
Medicare-Approved Amount. In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference.
What is a Part B deductible?
deductible. The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay. applies. Medicare pays the. supplier.
How to find out how much a test is?
To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like: 1 Other insurance you may have 2 How much your doctor charges 3 Whether your doctor accepts assignment 4 The type of facility 5 Where you get your test, item, or service
Does Medicare cover CPAP machine rental?
If you had a CPAP machine before you got Medicare, Medicare may cover CPAP machine cost for replacement CPAP machine rental and/or CPAP accessories if you meet certain requirements.