Palmetto GBA revises sleep study documentation and billing requirements

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, [...]

2023-05-12T13:15:20-05:00May 12th, 2023|Payer Advocacy|

AASM continues to advocate for prior authorization reform

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 [...]

2023-03-24T11:07:03-05:00March 24th, 2023|Payer Advocacy|

Phrenic nerve stimulation CPT codes coming in 2024

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 [...]

2023-01-27T17:51:46-06:00January 27th, 2023|Payer Advocacy|

AASM successfully advocates to resolve Medicare audit issue

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 [...]

2022-12-07T16:24:47-06:00November 2nd, 2022|Featured, Payer Advocacy|
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