On June 4, 2008, TrailBlazer Health published a revision to its local coverage determination (LCD), “Sleep Studies and Overnight Oximetry.” The American Academy of Sleep Medicine (AASM) worked closely with representatives from TrailBlazer on the development of this policy and provided expert input as well as evidence-based information. The full policy can be accessed online at www.trailblazerhealth.com/Tools/Local%20Coverage%20Determinations/Default.aspx?ID=2052&DomainID=1 The LCD is effective immediately.
According to the LCD, unattended portable sleep studies (95806, G0399 and G0400) are not indicated for the routine assessment of obstructive sleep apnea or other sleep disorders. When trained personnel are not physically present throughout a recording session, the polysomnogram is considered “unattended” and is not covered.
Further, the LCD states, “Medicare has determined there is not sufficient evidence to conclude that unattended portable multi-channel sleep study testing (95806, G0398, G0399 and G0400) is reasonable and necessary in the diagnosis of OSA for CPAP therapy, and these tests are non-covered for this purpose. Polysomnography (95808, 95810 or 95811) must be performed in a facility-based sleep study laboratory, not in the home or in a mobile facility.”
This LCD affects Part A fiscal intermediaries in the following geographic jurisdictions:
Texas, New Mexico, Colorado, Indian Health Services, End Stage Renal Disease (ESRD) facilities, Skilled Nursing Facilities (SNF), and Rural Health Clinics (RHCs).
Visit www.aasmnet.org for a complete listing of all LCD policies.