Since the publication of national coverage determination (NCD) 240.4 by the Centers for Medicare & Medicaid Services (CMS) in March, the American Academy of Sleep Medicine (AASM) continues to work directly and closely with local Medicare carriers to develop local coverage determination (LCD) policies for continuous positive airway pressure (CPAP) therapy. A primary objective of the AASM’s efforts is to ensure the LCD policies are comprehensive and include the AASM’s clinical guidelines for unattended portable monitoring.
The AASM is also working with Correct Coding Solutions, LLC to lobby CMS to clarify ambiguities in NCD 240.4 and to determine which CPT codes can or cannot be billed on the same date of service as a G-code. After the publication of NCD 240.4, the AASM sent a letter to CMS requesting clarification on several areas of the policy and requested the agency address these questions. To date, the AASM has not received a response from CMS. The AASM and CCS are working together to again request clarification from CMS, especially the definition of the three required channels for a type IV monitor.
Finally, Dr. Chediak on behalf of the AASM has sent a letter to CMS supporting a separate HCPC Code for auto-titrating positive airway pressure (APAP) with the caveat that the code would clearly define the certain conditions in which APAP is appropriate according to the published practice parameters.