Thank you for choosing Oxygen One
Referring to Oxygen One for sleep therapy is as simple as faxing the following to our office:
- Phone number
- Insurance information
Five Element Order Prescription including:
- Patient's name
- Description of the item
- Provider signature
- Provider's NPA
**Click here to download a Positive Airway Pressure Prescription**
Physician signed clinical notes from a face to face visit up to 6-months prior to a sleep study, supporting medical necessity and discussing symptoms. A chart note’s primary purpose is to demonstrate the clinical necessity and show why the patient requires therapy.
A valid note should include:
- Signs and symptoms of sleep-disordered breathing (snoring, daytime sleepiness, observed apneas, choking or gasping during sleep, morning headaches)
- Duration of symptoms
- Validated sleep hygiene inventory such as the Epworth Sleepiness Scale
- Physical exam
- Focused cardiopulmonary and upper airway system evaluation
- Neck circumference
- Body mass index (BMI)
Board certified or eligible sleep physician interpretation of a sleep study (PSG or home sleep test) with a copy of tracings where either the patient’s apnea-hypopnea index (AHI) or Respiratory Disturbance Index (RDI) is greater than or equal to 15 events per hour with a minimum of 30 events; or the AHI or RDI is greater than or equal to 5 and less than or equal to 14 events per hour with a minimum of 10 events and documentation of excessive daytime sleepiness, impaired cognition, mood disorders, or insomnia.
Please remember, after 3 months of therapy, we will need documentation of another face-to-face appointment with the patient confirming the diagnosis of OSA, demonstrating the compliant use of PAP therapy and a benefit from using therapy/improvement of symptoms.
For further information on Medicare’s coverage guidelines, click here for their Local Coverage Determination of Wisconsin.
Click on the following links for a qualification flow chart to assist in determining if your patient qualifies for a CPAP/AutoPAP, BiPAP, or BiPAP-ST.
If you have questions about the referral process at any time, please contact our office for assistance.