On Friday, TrailBlazer, the Medicare Carrier for Colorado, New Mexico, Oklahoma and Texas released its new local coverage determination policy, "Polysomnography and Sleep Studies." The policy goes into effect today.
According to the policy, the following requirements must be met when performing HST for coverage:
The physician performing the service must meet one of the following:
- The physician is a diplomate of the American Board of Sleep Medicine (ABSM).
- The physician is a diplomate in sleep medicine by a member board of the American Board of Medical Specialties (ABMS).
- The physician is an active staff member of a sleep center or laboratory accredited by the American Academy of Sleep Medicine (AASM) or The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)).
A home sleep test is covered only when it is performed in conjunction with a comprehensive sleep evaluation and in patients with a high pretest probability of moderate to severe obstructive sleep apnea. Home sleep testing is not covered for persons with comorbidities (moderate to severe pulmonary disease, neuromuscular disease or congestive heart failure), other sleep disorders (central sleep apnea, periodic limb movement disorder, insomnia, parasomnias, circadian rhythm disorders or narcolepsy), or for screening asymptomatic persons.
Access the full policy by clicking here.