Changes in CMS DME Policy Coverage Go Into Effect Jan. 1

On Jan. 1, 2010, additional coverage requirements in the Centers for Medicare & Medicaid Services (CMS) Durable Medical Equipment (DME) coverage policy will go into effect for all sleep tests.

The DME policy currently states that in order to receive coverage for a Home Sleep Test (HST) (Type II, III, or IV), the test must be interpreted by a physician who holds either:

• Current certification in Sleep Medicine by the American Board of Sleep Medicine (ABSM); or,
• Current subspecialty certification in Sleep Medicine by a member board of the American Board of Medical Specialties (ABMS); or,
• Completed residency or fellowship training by an ABMS member board and has completed all the requirements for subspecialty certification in sleep medicine except the examination itself and only until the time of reporting of the first examination for which the physician is eligible; or,
• Active staff membership 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).

The policy change is that beginning on Jan. 1, 2010, physicians interpreting facility-based polysomnograms (Type I) also must meet one of the requirements listed above to receive coverage. Members can review the full DME policy online.