Coding Articles
By the Coding and Reimbursement Advisory Committee Cognitive behavioral therapy for insomnia (CBT-I) is the first-line, evidence-based treatment for chronic insomnia. Unlike pharmacological approaches, CBT-I focuses on identifying and modifying the thoughts and behaviors that perpetuate sleep difficulties. It has been shown to [...]
The Centers for Medicare & Medicaid Services finalized the 2026 Quality Payment Program final rule on Nov. 5, 2025, introducing updates to the quality, cost, improvement activities, and Merit-based Incentive Payment System value pathways (MVP) categories. This rule also includes details on future [...]
Following the implementation of downcoding policies by two major private payers, Aetna and Cigna, effective Oct. 1, 2025, AASM analyzed payer trends and identified additional health plans with active or proposed downcoding programs targeting higher-level evaluation and management (E/M) services. These include Ambetter [...]
UnitedHealthcare has announced plans to significantly narrow coverage for remote patient monitoring services across both its Medicare Advantage and commercial plans, effective Jan. 1, 2026. Under the revised policy, remote patient monitoring will be considered reasonable and necessary only for patients with heart [...]
In response to advocacy by the American Academy of Sleep Medicine and other medical organizations, Cigna has agreed to pause its automatic downcoding policy — Evaluation and Management (E/M) Coding and Accuracy Policy (R49) — effective Oct. 1, 2025. In the AASM’s letter [...]
By the Coding and Reimbursement Advisory Committee Remote monitoring services refer to the use of digital technologies to collect, transmit and analyze health data from patients outside of traditional health care settings, such as in their homes. These services enable health care professionals [...]
On June 9, 2025, the Centers for Medicare & Medicaid Services (CMS) published a national coverage determination (NCD) memo for noninvasive positive pressure ventilation (NIPPV) in the home for chronic respiratory failure (CRF) due to chronic obstructive pulmonary disease (COPD). This decision introduces [...]
Hypoglossal nerve stimulation for treating obstructive sleep apnea (OSA) became a viable clinical option following its FDA approval in the United States in 2014. Sleep medicine providers will typically bill codes 95970, 95976 and 95977, which are used for the programming and analysis [...]
The American Academy of Sleep Medicine (AASM), along with the American Academy of Neurology (AAN), American Thoracic Society (ATS), and American College of Chest Physicians (CHEST) is participating in a joint AMA/Specialty Society Relative Value Scale Update Committee (RUC) survey on the codes [...]
The sleep medicine phrenic nerve stimulation codes became effective Jan. 1, 2024. They were created because of advances in phrenic nerve stimulation technology, improved diagnostic precision, and recognition of clinical needs in sleep medicine, all of which facilitated reimbursement and payer clarity. The [...]