Sleep Medicine

Polysomnography

Polysomnography (PSG), a type of sleep study, is a multi-parametric test used in the study of sleep and as a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG.

View clarification of Sleep lab credentialing within the coverage article and Local Coverage Determination (LCD).

Home Sleep Testing (HST)

  • Portable monitoring in beneficiary's home with Sleep Test
  • Covered only when performed in conjunction with comprehensive sleep evaluation
    • With patients having high pretest probability of moderate to severe Obstructive Sleep Apnea (OSA)
  • Physician services related to HST covered
    • Testing patient for diagnosis of OSA or Hypersomnia
    • Reasonable/necessary for diagnosis of condition
    • Meets all other Medicare requirements
    • Physician who performs service has enough training and experience to reliably perform service
  • Only covered only for OSA diagnosis:
    • G0398 - Home Sleep Study Test (HST) with Type II portable monitor, unattended, minimum of 7 channels
    • G0399 - Home Sleep Study Test (HST) with Type III portable monitor, unattended, minimum of 4 channels
    • G0400 - Home Sleep Study Test (HST) with Type IV portable monitor, unattended, minimum of 3 channels (e.g. Watch-PAT devices (Itamar Medical))
    • Place of Service = Home (12), Assisted Living (13) or mobile Independent Diagnostic Testing Facility (IDTF) (15)
    • Contractor Status Code (C-Status) special allowables annually
  • Not covered for other sleep disorders (narcolepsy, parasomnias, central sleep apnea, periodic limb movement, insomnia, circadian rhythm disorders or screening asymptomatic beneficiaries)
  • Documentation needs:
    • Patient referred by attending physician with physician's order kept in medical record
    • Show HST performed in conjunction with comprehensive sleep evaluation and patient's high pretest probability of moderate to severe OSA
    • Patient received, prior to test, adequate instruction how to apply portable sleep device
    • Must show HST accomplished with Medicare-approved device (e.g., description of channels monitored or clear indications of same included in test report)
    • Performed by physician meeting training requirements
    • Parameters monitored and documented:
      • Total sleep time, sleep efficiency, number/duration of awakenings.
      • Tests involving sleep staging: time and percent time spent in each stage;
      • Tests monitoring sleep latency or maintenance of wakefulness testing: latency to both Non-Rapid Eye Movement (NREM) and Rapid Eye Movement (REM) sleep.
      • Individual sub-test sleep latencies mean sleep latency and the number of REM occurrences on Multiple Sleep Latency Test (MSLT).
      • Respiratory patterns including type (central/obstructive/periodic), number and duration, effect on oxygenation, sleep stage/body position relationship and response to any diagnostic and /or therapeutic maneuvers.
      • Cardiac rate/rhythm and any sleep-disordered breathing effect on electrocardiogram (EKG or ECG).
    • Detailed behavioral observations
    • Electroencephalogram (EEG) or electromyography (EMG) abnormalities

Polysomnography (PSG)

  • Three (3) forms sleep apnea (obstructive/central/mixed) with OSA most common
  • Continuous monitoring/recording of physiological sleep parameters (six (6) hours/more)
  • Overnight stay at sleep lab or IDTF or Hospital or freestanding facility
  • By trained technician to monitor/assess patient
  • Under "supervision of or referred by" attending physician for review/interpretation/report

Resources

Last Updated Sep 12 , 2024