Palmetto, the Medicare Carrier for California, Nevada, and Hawaii, recently published its draft Local Coverage Determination (LCD) for "Polysomnography and Sleep Studies for Testing Sleep and Respiratory Disorders." The draft, unlike Palmetto’s current LCD, contains language that will cover for home sleep tests (HST), but only under certain conditions.
The daft policy states:
"The polysomnography must be performed in a facility-based sleep study laboratory, and not in the home or in a mobile facility.
Performance of home sleep testing is limited to FDA-cleared devices furnished with adequate patient instruction and support to assure successful completion of the studies. Provision of the device, patient instruction and support can be provided by accredited sleep centers as well as independent diagnostic testing facilities (IDTF) and other entities that can demonstrate use of FDA-approved devices, inspection of the devices, and the patient support activities required. The provider may be subject to post payment audit to document these activities.
The DMAC (Durable Medical Equipment Administrative Contractors) are responsible for providing coverage guidance on CPAP devices. The DMACS have published a policy that requires the following standards of credentialing for individuals who interpret the sleep testing results that are required for coverage of CPAP.
"Home sleep testing must be interpreted by a physician who holds either:
- Current certification in Sleep Medicine by the American Board of Sleep Medicine (ABSM); or
- Current subspecialty certification in Sleep Medicine by a member board of the American Board of Medical Specialties (ABMS); or
- Completed residency or fellowship training by a program approved by an ABMS member board and has completed all the requirements for subspecialty certification in sleep medicine except the examination itself and only until the time of reporting of the first examination for which the physician is eligible; or
- Active staff membership of a sleep center or laboratory accredited by the American Academy of Sleep Medicine or the Joint Commission.
Note: Physicians interpreting polysomnograms will be required to meet this requirement for coverage of PAP devices provided after January 1, 2010."
Member can view the full policy on the CMS Web site by clicking here.
Palmetto is allowing for comments on the policy. Interested individuals may submit comments from10/30/2008 through 12/15/2008 by e-mail: Kathy.Sheehan@Palmettogba.com.