States and professional organizations are increasingly challenging private insurers' downcoding of evaluation and management (E/M) services, a practice clinicians say undermines physician judgment and delays appropriate reimbursement. E/M downcoding occurs when payers automatically reduce the level of a clinician-reported E/M code, resulting in [...]
The American Academy of Sleep Medicine recently sent a letter to UnitedHealthcare, raising concerns about the use of Synapse Health for durable medical equipment (DME) fulfillment for CPAP therapy. The letter outlined member‑reported issues affecting patient access to care and clinical workflows. AASM [...]
The American Academy of Sleep Medicine recently sent a letter to Wellmark to raise concerns about a payer policy affecting reimbursement for in-lab diagnostic and titration sleep studies. The policy restricts reimbursement for Current Procedural Terminology (CPT) codes 95810 (diagnostic polysomnography) and 95811 (polysomnography with PAP titration) when [...]
On Feb. 25, 2026, the Centers for Medicare & Medicaid Services (CMS) hosted the 2026 CMS Burden Reduction Conference, uniting stakeholders in person and virtually for a focused discussion on minimizing administrative burden across the health care sector. The panel addressed transparency in [...]
Centers for Medicare & Medicaid Services (CMS) have acknowledged stakeholder questions regarding the appropriate coding for hypoglossal nerve neurostimulator procedures used to treat obstructive sleep apnea. Specifically, CMS recognized that existing Current Procedural Terminology (CPT) codes do not fully describe certain newer systems. [...]
On Feb. 27, the Centers for Medicare & Medicaid Services (CMS) published a notice announcing a nationwide, six-month moratorium on the enrollment of new durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers in Medicare. The moratorium, effective immediately, is intended to help [...]
As part of the Consolidated Appropriations Act, 2026, which ended the recent partial government shutdown, Congress extended several Medicare telehealth flexibilities through Dec. 31, 2027. These policies, originally introduced during the COVID-19 public health emergency, were set to expire Jan. 30, 2026. The [...]
After advocacy efforts by the American Academy of Sleep Medicine and other medical organizations, UnitedHealthcare has announced a delay in implementing its remote patient monitoring policy. The AASM recently submitted a letter to UnitedHealthcare opposing its new remote patient monitoring policy and the [...]
On Jan. 2, 2026, the Centers for Medicare & Medicaid Services (CMS) announced that Merit-Based Incentive Payment System (MIPS) submissions for the Quality Payment Program (QPP) can be submitted through 8 p.m. ET March 31, 2026. The AASM has developed the AASM MIPS Submission [...]
The Centers for Medicare & Medicaid Services released the CY 2026 Medicare physician fee schedule (MPFS) final rule on Oct. 31, 2025. AASM submitted a comprehensive comment letter to CMS outlining priority policy changes to protect patient access to sleep medicine services, ensure [...]