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We ingest, normalize, and version every Medicare, Medicaid, and commercial coverage policy. Our models apply them automatically — with citations you can audit.
Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
Indications
• Face-to-face evaluation by treating practitioner prior to sleep test. • Sleep test meeting Medicare criteria (AHI/RDI ≥ 5 with symptoms, or ≥ 15). • Education on proper PAP use provided.
Continued coverage
Beneficiary must be re-evaluated 31–91 days after initiation. Documentation must show adherence (≥ 4 hours per night on 70% of nights over 30 consecutive days) and clinical benefit.
Covered codes
E0601 · E0470 · E0471 · A7030 · A7031 · A7032 · A7033 · A7034 · A7035 · A7036 · A7037 · A7038 · A7039 · A7046
AI interpretation
This policy is fully encoded. When a PA request is submitted for E0601, our model checks all 14 covered criteria, flags missing documentation, and drafts language citing the specific clause triggered.
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LCDs, NCDs, commercial medical policy, state Medicaid guidelines. 50+ payers and growing.
Full version history
Retroactive review stays accurate. Our models always use the policy version in effect on the service date.
Cited decisions
Every AI decision points to the exact policy clause. No black-box interpretations.
Cross-payer mapping
See how a clinical scenario maps across payers. Helps providers route optimally.