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March 2015 Tip of the Month:
Can Medicare patients get home sleep tests?
The short answer is yes, but if your practice is enrolled as a Medicare DME supplier location, you should not be the one administering home sleep tests (HST's) to your Medicare patients!
It is also important to understand that a patient must follow the proper path to diagnosis in order for the oral appliance for OSA to be covered by Medicare. The good news is, HST's may be an option!
The Medicare Local Coverage Determinations (LCD's) for Oral Appliances for Obstructive Sleep Apnea (OSA) states:
"Coverage of an oral appliance for the treatment of OSA is limited to claims where the diagnosis of OSA is based upon a Medicare-covered sleep test (Type I, II, III, IV, Other). A Medicare-covered sleep test must be either a polysomnogram performed in a facility-based laboratory (Type I study) or a home sleep test (HST) (Types II, III, IV, Other). The test must be ordered by the beneficiary's treating physician and conducted by an entity that qualifies as a Medicare provider of sleep tests and is in compliance with all applicable state regulatory requirements."
The LCD goes on to state:
"All beneficiaries who undergo a HST must, prior to having the test, receive instruction on how to properly apply a portable sleep monitoring device. This instruction must be provided by the entity conducting the HST and may not be performed by a DME supplier. Beneficiary instruction may be accomplished by either:
1. Face-to-face demonstration of the portable sleep monitoring device’s application and use; or,
2. Video or telephonic instruction, with 24-hour availability of qualified personnel to answer questions or troubleshoot issues with the device.
All sleep tests must be interpreted by a physician who holds either:
1. Current certification in Sleep Medicine by the American Board of Sleep Medicine (ABSM); or,
2. Current subspecialty certification in Sleep Medicine by a member board of the American Board of Medical Specialties (ABMS); or,
3. Completed residency or fellowship training in a program approved 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,
4. Active staff membership of a sleep center or laboratory accredited by the American Academy of Sleep Medicine (AASM), Accreditation Commission for Health Care (ACHC) or The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations – JCAHO).
No aspect of an HST, including but not limited to delivery and/or pickup of the device, may be performed by a DME supplier. This prohibition does not extend to the results of studies conducted by hospitals certified to do such tests."
You can view the full LCD here on Noridian's website (Medicare DME MAC for Jurisdiction D):
https://www.noridianmedicare.com/dme/coverage/docs/lcds/current/oral_appliances.htm
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