In mid-November the Centers for Medicare & Medicaid Services (CMS) published the 2016 Hospital Outpatient Prospective Payment System (OPPS) Final Rule, which finalized recommended changes outlined in the proposed rule published this summer. However, proposals to drastically cut payment to in-center sleep testing were averted following comments submitted by the American Academy of Sleep Medicine.

Under the OPPS, procedures are assigned to what is known as ambulatory payment classifications (APCs). The 2016 OPPS proposed rule recommended changes to the APCs for diagnostic testing, including APCs for sleep testing. These changes were anticipated to cut payment to the MSLT and pediatric polysomnography by approximately 50%. In the 2016 OPPS final rule, CMS finalized its plans to change the APC categorizations; however, modifications were made to the recommended categorizations for sleep testing. CMS recognized that initial categorizations for pediatric polysomnography and the MSLT were not reflective of the clinical characteristics and resource use for these complex procedures. CMS therefore finalized APCs for these two services that will pay at rates almost identical to the 2015 rates for these procedures.

The chart below describes the new 2016 APCs and payment rates for sleep testing:

HCPCS/CPT Code  Short Descriptor   2016 APC 2016 Payment Rate
 95782  Polysom <6 yrs 4/> paramtrs  5724  $856.44
 95783  Polysom <6 yrs cpap/bilvl  5724  $856.44
 95800  Slp stdy unattended  5721  $129.75
 95801  Slp stdy unatnd w/anal  5734  $91.18
 95803  Actigraphy testing  5734  $91.18
 95805  Multiple sleep latency test  5724  $856.44
 95806  Sleep study unatt & resp efft  5721  $129.75
 95807  Sleep study attended  5723  $396.52
 95808  Polysom any age 1-3> param  5724  $856.44
 95810  Polysom 6/> yrs 4/> param  5724  $856.44
 95811  Polysom 6/> yrs cpap 4/> param  5724  $856.44