Two durable medical equipment (DME) Medicare Administrative Contractors (MACs) — CGS Administrators, LLC and Noridian Healthcare Solutions, LLC — have released “Dear Physician Letters” to highlight requirements for sleep study scoring. Per the MACs, adhering to the information provided in the letters will allow you to ensure that you are documenting and sharing the correct information with suppliers while also providing the best care for your patients by helping them obtain and keep the needed equipment in accordance with DME MAC requirements.
Here is an excerpt from the letters:
For Medicare patients, make sure that you use the correct scoring of hypopneas when you interpret the PSG. Medicare uses the 4% O2 desaturation, not the AASM 3% definition. For patients who may currently be under commercial or non-Medicare insurance coverage, consider scoring patients using both the 3% and 4% O2 desaturation metric and provide a separately-scored AHI based on each metric in your interpretation report. By providing an AHI scored with both hypopnea definitions, this will allow your patient to use the PSG once they are Medicare eligible.
Please note that the letters are duplicates of each other, so providers in each DME MAC Jurisdiction can access a copy of the letter from the appropriate DME MAC. You can identify your DME MAC using the table on the Medicare Policies page of the AASM website. Both letters can be accessed below, and links are provided to help you contact each DME MAC to request any clarification that may be needed:
For additional context about this topic, read the AASM position statement, “Polysomnography for Obstructive Sleep Apnea Should Include Arousal-Based Scoring.”
Find helpful sleep medicine coding and reimbursement information in the AASM Coding FAQs. AASM members may send sleep medicine coding and reimbursement questions to coding@aasm.org.
