Medicare only covers type I tests if performed in a sleep laboratory. Your doctor should order the test. Medicare only covers type I tests if performed in a sleep laboratory. It depends on the circumstances that require the new study.
There is no lifetime limit for sleep studies. In general, an initial diagnostic PSG and a follow-up titration to assess efficacy should be all that is needed for several months, unless it is an extraordinary change in the patient's well-being. An example is if the patient discontinues CPAP therapy or fails to do so during the three-month trial period. Then, the trial and trial period should start again.
Sleep studies are covered by Medicare Part B health care coverage. And because Medicare Advantage insurance plans (Medicare Part C) are required by law to provide the same coverage as Part A and Part B, sleep studies are also covered by these private Medicare plans. Sleep studies are covered by Medicare Part B. You'll need to pay 20 percent of the Medicare-approved study cost and Part B deductible applies.
CMS also grants geographical jurisdictions to private health care insurers called Medicare Administrative Contractors (MACs) to develop policies and process claims. The policies developed by MACs are called Local Coverage Determinations (LCDs) and can vary from region to region. An LCD can never contradict an NCD, but it can expand coverage policies for a particular region. Countless snorers have thought without a doubt, as they packed their pajamas and headed to the sleep lab to study during the night, “Wow, it would be nice if I could do this at home in my own bed.
In fact, home studies, also known as portable monitoring, have been around since CPAP. But persistent questions about their reliability, and the consequent refusal of most insurers to pay for them, have kept them out of the mainstream of practice. In March, the Centers for Medicare and Medicaid Services, whose reimbursement rules are generally adopted by private insurers, abandoned their long-standing opposition to homeschooling. According to the National Coverage Determination released that month, a diagnosis of obstructive sleep apnea can be made and CPAP therapy covered based on a clinical evaluation along with a home study using a device that measures, at a minimum, air flow, heart rate, and blood saturation oxygen.
The NCD specifies that the home study should be ordered and supervised by the attending physician. It also limits initial CPAP coverage to a 12-week trial period. The prevalence of sleep-disordered breathing, combined with a shortage of laboratories that could perform the required polysomnographic studies, led to unacceptable delays in diagnosis and treatment. Citing a series of studies, the organization stated that “home sleep testing is a validated alternative to laboratory testing, and stated that “it is the responsibility of CMS to lead the way in improving diagnostic and treatment paradigms by covering portable monitoring.
But some doctors' doubts about home studies have to do with the fundamental nature of sleep disorders and sleep itself. Steven Feinsilver, a sleep medicine specialist who teaches at New York University, points out that while a portable device that measures airflow can detect respiratory disorders, it cannot diagnose sleep breathing disorders, since it cannot tell if a person is, in fact, asleep. This low-tech approach, which certainly has the drawback of requiring a bed partner, is not likely to be the future of OSA therapy. At this time, however, it is not possible to say what that future will be.
Portable monitoring may be used in appropriate and selected populations of comparatively healthy patients with relatively simple SDB, with laboratory studies reserved for more complex situations, increasing access to care for all. Or it could be financial considerations: A laboratory study costs about three times more than a home study becomes paramount, making polysomnography a luxury item for those who can afford Cadillac care. Or, in an even worse scenario, the market may be flooded with poor quality home devices that make proper diagnosis and treatment more difficult to achieve. For a sleep study to be covered, it must be requested by a licensed physician.
In the past, all sleep studies had to be done in a Medicare-approved sleep laboratory. However, Medicare is approving more home studies for coverage. These studies are much more convenient, and their results can lead to a diagnosis when combined with a visit to the doctor. Medicare covers sleep studies when your doctor orders the test to diagnose certain conditions, such as sleep apnea, narcolepsy, and parasomnia.
If your sleep problems become chronic and begin to affect your daily activities and overall health, help is available. HST cannot be performed on children and cannot diagnose other sleep disorders, such as restless leg syndrome, periodic limb movement disorder, or narcolepsy. Typical symptoms include heavy snoring, drowsiness or excessive fatigue during the day, difficulty concentrating or memorizing, among many others. Medicare initially limits coverage of a CPAP machine to a 12-week rental period, during which the doctor evaluates any improvement in your condition as a result of using the machine.
Familiarize Yourself with Diagnosis, Tests, Treatment Options, and How to Cope with the Lifelong Effects of Sleep Apnea. This retainer-type medical oral appliance is one of the sleep apnea devices covered by Medicare if the situation qualifies. AASM accreditation demonstrates a sleep medication provider's commitment to high-quality, patient-centered care by meeting these standards. The Medicare Provider and Provider Enrollment webpage provides additional details on how to enroll as a Medicare provider or provider.
Here is an excellent article from the Sleep Review magazine on 9 attributes to consider when choosing HST devices. . .