After receiving a letter submitted by the American Medical Association (AMA) and more than 100 medical societies, including the American Academy of Sleep Medicine (AASM), Cigna has announced a delay in implementation of its recently revised modifier 25 policy. Modifier 25 enables reporting of [...]
On May 3, the Drug Enforcement Administration (DEA) published a temporary extension of COVID-19 telemedicine flexibilities for prescription of controlled medications for six months, from May 12, 2023, through Nov. 11, 2023, provided all appropriate conditions are met. The rule also provides for a [...]
On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Medicare Advantage and Part D final rule. This rule summarizes finalized changes to the Medicare Advantage (Medicare Part C), prescription benefit coverage (Medicare Part D), Medicare Cost Plan, and Programs [...]
Palmetto GBA, a Medicare administrative contractor (MAC) for Medicare jurisdictions J and M, revised the polysomnography Local Coverage Determination (LCD) L36593 and its accompanying Local Coverage Article A56995 effective March 16, 2023, to update documentation and billing requirements. These jurisdictions include Alabama, Georgia, Tennessee, [...]
After receiving several inquiries from AASM members expressing concern that Blue Shield of California is denying reimbursement for positive airway pressure (PAP) therapy when a device with only one respiratory monitoring belt is used in performing the patient’s diagnostic sleep study, the AASM sent [...]
The AASM continues to advocate for prior authorization reform to allow clinicians to provide medically necessary care in a timely manner for patients with sleep disorders. Medicare Advantage organizations are currently at the forefront of national reform efforts, given recent studies and initiatives, by [...]
The AASM worked with the American College of Cardiology (ACC) and the Heart Rhythm Society (HRS) to convert 12 phrenic nerve stimulation (PNS) Category III codes to Category I codes. The AMA Current Procedural Terminology (CPT) Editorial Panel accepted the addition of codes 3X008-3X015 [...]
Effective Jan. 1, 2023, the Centers for Medicare & Medicaid Services (CMS) no longer requires Certificates of Medical Necessity and DME Information Forms for selected durable medical equipment (DME). This documentation was originally required to help confirm medical necessity and other coverage criteria. Historically, [...]
The Centers for Medicare & Medicaid Services (CMS) published the 2023 Physician Fee Schedule Final Rule in November. An analysis of the rule, including key highlights specific to sleep medicine, is included below. This analysis includes updated comparison documents to help sleep clinicians [...]
AASM staff, leadership and members, in coordination with AASM’s lobbying firm, McDermott+Consulting, have been working to resolve an urgent issue arising from an uptick in member audits involving claims for follow-up diagnostic sleep studies performed as required in local coverage determination policies. AASM members [...]
