Aetna Pauses CPAP Reimbursement Change After Concerns

Aetna has decided to pause a proposed change regarding the reimbursement of CPAP devices and supplies that was set to take effect on April 1, 2025. This decision came after the American Association for Homecare (AAHomecare) raised concerns about the new adherence code requirements, which would prevent durable medical equipment (DME) providers from billing certain adherence codes. AAHomecare emphasized the importance of maintaining uninterrupted patient care for those relying on CPAP therapy.

The proposed change, which aimed to ensure that claims for CPAP devices must include specific adherence codes (G8851, G8854, and G8855), has faced pushback, particularly during the initial 90 days of usage when compliance is still being evaluated. AAHomecare's request for Aetna to rescind this requirement is underscored by potential disruptions this change could cause to patient care.

Moreover, AAHomecare referenced provisions from the 2024 Medicare Advantage and Part D Final rule, arguing that Aetna's adherence code requirement does not align with Medicare's existing coverage criteria. They have requested formal communication from Aetna to the supplier community regarding the hold on the proposed change.