Sleep Medicine - JE Part A
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
- 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
- CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 70
- Accreditation Commission for Health Care (ACHC)
- American Academy of Sleep Medicine (AASM)
- CMS Medicare Provider Compliance Tips - Polysomnography (Sleep Studies)
- Office of Inspector General (OIG) Polysomnography Report
- OIG 2019 Audit - Polysomnography Services
- The Joint Commission
Last Updated Thu, 20 Jan 2022 19:32:34 +0000