CMS Posts NCD for OSA Sleep Testing

Effective for claims with dates of service on and after March 3, 2009, Medicare will allow for coverage of certain sleep testing devices. The Centers for Medicare & Medicaid Services (CMS) posted, July 21, a National Coverage Determination (NCD) for sleep testing of obstructive sleep apnea (OSA) (240.4.1).

Specifically, Medicare will allow for coverage of the following sleep testing devices:

  • Type 1 PSG, when the test is attended in a sleep lab facility;
  • Type II or Type III, if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility; or
  • Type IV measuring three or more channels, one of which is airflow, if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.

To report facility led sleep tests, coders have the following CPT® 2009 codes:

  • 95808  Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
  • 95810  Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
  • 95811  Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist

In March 2008, CMS added the following HCPCS Level II G codes to report HST:

  • G0398  Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
  • G0399  Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
  • G0400  Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels

For 2010, the proposed status indicator for these G codes is ‘S’ (Significant procedure, not discounted when multiple), the Ambulatory Payment Classification (APC) is 0213, and the payment rate is $159.91.

Implementation is Aug. 10. For more information related to this NCD, read CMS issue transmittal 103 or MLN article MM6534.

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One Response to “CMS Posts NCD for OSA Sleep Testing”

  1. Susan says:

    Our facility has unattended sleep studies. The patient sleeps at the VA, just as if they were at home, and there is no attending technologist. We are using code 95806. Is that the correct code? Should we be using a G code?

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