Sleep testing – 2013 payment analysis

The 2013 Medicare Physician Fee Schedule (MPFS) final rule was published on Nov. 16. The fee schedule finalizes payment rates for all physician services, including payment rates for sleep testing.  Payment for all services in the MPFS is calculated by multiplying the relative value units (RVUs) assigned to each component of the service by the designated conversion factor for the year. This article provides summary information about the payment rates for sleep testing effective Jan. 1, 2013. 

Conversion Factor

The conversion factor is a dollar amount, established by the Centers for Medicare & Medicaid Services (CMS) each year. This dollar amount helps determine reimbursement for all services paid under the MPFS, including sleep services. For 2013, CMS has calculated a conversion factor of $25.0008, which is a cut of almost 27 percent of the current, 2012 conversion factor rate of $34.0376. The conversion factor calculation is based on the Sustainable Growth Rate (SGR) formula and this significant payment reduction will be implemented on Jan. 1, 2013 unless Congress takes action to delay the cut during the lame duck session.

Changes to Sleep Testing RVUs

According to the 2013 MPFS final rule, the RVUs assigned to physician work and professional liability insurance for sleep testing will not change in 2013. However, the RVUs for practice expense for sleep testing will change. In the case of out of center sleep testing codes (95800 and 95801) practice expense will increase in 2013. Practice expense for the in-center polysomnography codes (95808, 95810, and 95811) will decrease by 3-4 percent. This cut is less than the 7-9 percent cut to practice expense projected in the MPFS proposed rule, which the AASM reported in July.  Sleep medicine has two new codes effective in 2013 – the pediatric sleep testing codes (95782 and 95783) have been assigned RVUs in the 2013 fee schedule.

National Payment

This chart reflects national payment if the conversion factor of $25.0008 is implemented

Code

Descriptor

2012 Total RVU

2013 Total RVU

RVU Difference

National Payment

95800

Sleep study, unattended w/ sleep time

4.73

5.37

+ 12%

$134.25

95801

Sleep study, unattended

2.54

2.80

+ 9%

$70.00

95803

Actigraphy testing

4.86

4.48

– 8%

$112.00

95805

MSLT/MWT

12.27

12.62

+ 3%

$315.51

95806

Sleep study, unattended w/ respir effort

5.40

5.39

$134.75

95807

Sleep study, attended

14.64

14.69

$367.26

95808

PSG, 1-3 additional parameters

19.73

19.23

– 3%

$480.77

95810

PSG, 6 yr or older, 4 or more additional parameters

19.47

18.99

– 3%

$474.77

95872

PSG, under 6 yr, 4 or more additional parameters

NA

31.35

NA

$783.78

95811

PSG, 6 yr or older, 4 or more additional parameters w/ PAP

20.76

19.92

– 4%

$498.02

95873

PSG, under 6 yr, 4 or more additional parameters w/ PAP

NA

32.83

NA

$820.78

The AASM will continue to provide members with up-to-date information about the 2013 conversion factor and payment for sleep services.  Members with questions regarding 2013 payment can contact AASM staff at coding@aasm.org.

2012-11-29T00:00:00+00:00 November 29th, 2012|Clinical Resources|