Cahaba, the Medicare Carrier for Alabama, Georgia and Mississippi, has issued its first Local Coverage Determination (LCD) for Home Sleep Testing (HST). The draft policy outlines the following parameters in order for one to receive coverage for HST.
Home Sleep Testing is not covered for:
- Comorbidities (moderate to severe pulmonary disease, neuromuscular disease or congestive heart failure).
- Other sleep disorders (central sleep apnea, periodic limb movement disorder, insomnia, parasomnias, circadian rhythm disorders, or narcolepsy).
- Screening asymptomatic persons.
- Watch-PAT100 (Itamar Medical) is not covered.
All sleep studies must be performed by a center/laboratory that meets the following criteria:
- Each center/laboratory must have as medical director a physician with a license valid in the state of the center.
- Technicians must work under the direction and control of a licensed physician, even though this test may be covered in the absence of direct supervision.
- Each center/laboratory must be accredited by and comply with the standards set by the American Academy of Sleep Medicine (AASM) or The Joint Commission (formerly The Joint Commission on Accreditation of Healthcare Organizations – JCAHO).
- Each study must be performed under the general supervision of the Sleep Physician who
- is a diplomate of ABSM (American Board of Sleep Medicine); or
- is board eligible to sit for ABSM certification exam.
A portable monitoring device for conducting a HST must meet one of the following criteria:
- Type II device: Monitors and records a minimum of seven (7) channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation; or,
- Type III device: Monitors and records a minimum of four (4) channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation; or,
- Type IV device: Monitors and records a minimum of three (3) channels that must include respiratory effort, airflow and oxygen saturation.
View the full policy on the CMS Web site by clicking here.
Please note that Mississippi will soon be changing carriers from Cahaba to Pinnacle. Once this transition occurs, physicians in Mississippi will need to follow the LCD policy issued by Pinnacle.
The comment period for the Cahaba LCD policy commences October 17, 2008, and the deadline is December 20. Comments can be submitted three ways:
Part B Medicare Medical Director
Post Office Box 13384
Birmingham, AL 35202-3384