The Medicare Administrative Contractor, Palmetto GBA, has published an updated local coverage determination (LCD) policy for polysomnography (L36593), effective for services performed on or after Jan. 1, 2019.
Palmetto GBA has revised the ICD-10 Codes that Support Medical Necessity Group 3 by adding the following ICD-10-CM codes:
- G47.11: Idiopathic hypersomnia
- G47.12: Idiopathic hypersomnia without long sleep time
Additionally, the following code has been deleted from ICD-10 Codes that Support Medical Necessity Group 3:
- R06.83: Snoring
The revisions to L36593 will directly impact sleep medicine professionals within Palmetto GBA’s Jurisdictions, J and M.
States in which Part A & B Claims are Processed
Palmetto GBA Jurisdiction J: Alabama, Georgia, Tennessee
Palmetto GBA Jurisdiction M: North Carolina, South Carolina, Virginia, West Virginia (excludes Part B for the counties of Arlington and Fairfax in Virginia and the city of Alexandria, VA)
The Centers for Medicare and Medicaid Services (CMS) awards geographical jurisdictions to private health care insurers called Medicare Administrative Contractors (MACs), to develop LCDs and process claims. National coverage determinations (NCDs) supersede LCDs, but LCDs expand on coverage policies for each jurisdiction. Coverage policies may vary, including information regarding appropriate coding, credentialing, diagnostic testing, and treatment.
All current sleep medicine Medicare policies can be accessed through the AASM website. Members may send coding and reimbursement questions to coding@aasm.org.
