Polysomnography and Other Sleep Studies (L36861) - R4 - Effective December 01, 2019

Date Posted: April 18, 2024

This Local Coverage Determination (LCD) has been revised under contractor numbers: 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV), and 01911 (CA, HI & Territories).

Effective Date: December 01, 2019

Summary of Changes: Under Coverage Indications, Limitations, and/or Medical Necessity, added the following information:

Beneficiaries who fail the initial 12-week trial are eligible to re-qualify for a PAP device but must have both:

  1. In-person clinical re-evaluation by the treating practitioner to determine the etiology of the failure to respond to PAP therapy; and,
  2. Repeat sleep test in a facility-based setting (Type 1 study). This may be a repeat diagnostic, titration or split night study.

These updates are effective December 01, 2019.

Visit the Active LCDs webpage to view the Active LCD or access it via the CMS MCD.

Last Updated Apr 18 , 2024