Medicare Approves Sleep Testing for Obstructive Sleep Apnea (OSA)

On March 3, 2009, CMS published the "Decision Memo for Sleep Testing for Obstructive Sleep Apnea." A summary of the decision follows:

"CMS finds that the evidence is sufficient to determine that the results of the sleep tests identified below can be used by a beneficiary's treating physician to diagnose OSA, that the use of such sleep testing technologies demonstrates improved health outcomes in Medicare beneficiaries who have OSA and receive the appropriate treatment, and that these tests are thus reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act.

Therefore:

      1.   Type I Polysomnography (PSG) is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) in beneficiaries who have clinical signs and symptoms indicative of OSA if performed attended in a sleep lab facility.

      2.   A Type II or a Type III sleep testing devise is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) in beneficiaries who have clinical signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.

      3.   A Type IV sleep testing devise measuring three or more channels, one of which is airflow, is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) in beneficiaries who have signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.

      4.   A sleep testing device measuring three or more channels that include actigraphy, oximetry, and peripheral arterial tone is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility."

Check out the complete decision memo and you can read a detailed explanation of sleep testing issues in the post "Medicare to Cover Sleep Disorder Treatments" in the PA Elder, the State and Fiduciary Law Blog.

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DR MIRZA - July 23, 2009 1:52 PM

I AM A SOLO PROVIDER IN NJ.I WANT TO PUT A SLEEP BED IN MY OFFICE.DO I NEED TO GET ANY ACCREDATION FOR IT IN ORDER TO BILL IT? OR I CAN BILL IT WITH MY CURRENT MEDICARE NO.PLEAE ADVISE.

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