AASM members and sleep centers in Medicare Jurisdiction 5 and Jurisdiction 8 should be aware of a new local coverage determination (LCD) policy issued by Wisconsin Physicians Service Insurance Corporation (WPS) Government Health Administrators regarding coverage for Polysomnography and Other Sleep Studies (L36839).

Effective Feb. 16, 2017, L36839 will apply new standards for providers and centers in determining coverage for sleep studies. L36839 replaces L34535, which was issued Oct. 1, 2015, and revised Oct. 1, 2016.

The new LCD (L36839) will no longer accept performance of the service based on a subspecialty of pulmonology or neurology alone, but requires that the performing physician be a diplomate of the American Board of Sleep Medicine, have a sleep certification issued by one of the listed Boards, or be an active physician staff member of a credentialed sleep center or laboratory that has active physician staff members meeting one of the two previously mentioned sleep certification criteria. In addition, L36839 requires the sleep center or laboratory to be credentialed by either the American Academy of Sleep Medicine (AASM) or another listed accreditor. The new LCD policy defines a sleep center or laboratory as “any site or place of service other than patient’s home where sleep studies or recordings are performed.

The new LCD will specifically impact providers and centers with Medicare Jurisdiction 5, which includes J5 National Part A and Parts A/B for the states of Iowa, Kansas, Missouri, and Nebraska, and Medicare Jurisdiction 8, which covers Parts A/B for Indiana and Michigan.

Should you have further questions about the new LCD, please contact Jay French, Director of Health Policy, at jfrench@aasm.org or 630-737-9700.