Earlier this week, the Centers for Medicare & Medicaid Services (CMS) notified the AASM that it will be establishing a Medicare physician specialty code for sleep medicine. The letter noted the important work that sleep medicine physicians provide for Medicare beneficiaries and stated that the request submitted by the AASM met all of the criteria for approval.

In the request that the AASM sent to CMS in September 2010, the AASM pointed out that board-certified sleep specialists have been prevented form participating in some formal Contractor Advisory Committee activities because sleep medicine was not recognized as a Medicare specialty.  The AASM also explained that the practice pattern of sleep medicine is markedly different from the six “parent” specialties that provide entry to the field.

Emphasizing that current data used to determine relative value units (RVUs) for sleep diagnostic services identify an array of medical specialists without identifying those physicians who specifically practice in the specialty of sleep medicine, the AASM outlined the following reasons why a physician specialty code for sleep medicine is necessary for the accurate development and application of the Medicare Physician Fee Schedule (MPFS):

  • A Medicare physician specialty code for sleep medicine will enable more accurate identification of MPFS practice expenses related to sleep medicine services since the practice expenses for physicians who are identified as sleep specialists differ from other medical specialists, even those specialists who work in related specialties.
  • A specialty code will assist CMS in its peer-to-peer comparison of services from specific specialties and in claims adjudication. It also will ease the process followed by durable medical equipment (DME) suppliers in identifying board-certified sleep medicine physicians.
  • A specialty code will provide a more effective means to identify episodes of care provided for patients with chronic sleep disorders, especially obstructive sleep apnea (OSA).

CMS noted that the establishment of a physician specialty code for sleep medicine will require changes to its enrollment and claims processing systems.  Therefore, it is expected that the change will be implemented no sooner than October 2011.  The AASM will provide members with additional details as they become available.