The Centers for Medicare & Medicaid Services (CMS) has finalized revisions to several local coverage determinations (LCDs) for oral appliances for obstructive sleep apnea, positive airway pressure (PAP) devices for obstructive sleep apnea, and respiratory assist devices. The revised policies will be effective Aug. 8.
CMS held an open meeting March 30 to seek comments on the proposed revisions, which included the removal of information regarding home sleep apnea tests (HSATs) from the documents and deferring to the national coverage determination (NCD). During the open meeting, Dr. K. Praveen Vohra, chair of the AASM Payer Policy Review Committee, presented comments on the proposed LCDs, including concerns that the following information, being removed from these LCDs, is not captured in the current NCD:
- Requirements for patient education on proper use of the HSAT devices
- Training and credentialing requirements
- Accreditation and certification requirements
The AASM also submitted a comment letter highlighting member concerns and requested that the NCD include the information being removed from the LCDs.
The following final LCDs (and associated policy articles and response to comments) were published June 24 with an effective date of Aug. 8, 2021:
- Oral Appliances for Obstructive Sleep Apnea LCD (L33611)
- Positive Airway Pressure (PAP) Devices for Obstructive Sleep Apnea (L33718)
- Respiratory Assist Devices (L33800)
While the DME MACs did not modify the LCDs to ensure inclusion of the patient education, credentialing, and accreditation requirements, they have confirmed that all A/B MAC LCDs and/or Billing and Coding articles for polysomnography address the patient education, credentialing, and accreditation concerns expressed in the AASM comments. The LCDs will be added to the AASM website, once effective.
Get more information about Medicare policies for the field of sleep medicine.