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Medicare Compliance & Reimbursement

READER QUESTION:

Nail Down Sleep Study Type To Determine Coverage

Published on Tue Jan 12, 2010

Medicare has strict requirements about tests performed in the patient's home. Question: Our practice is considering providing home sleeps studies. Does Medicare cover sleep studies when performed in the patient's home? Answer: As is often the case, the answer is, "it depends." In March 2008, Medicare expanded its National Coverage Determination (NCD) for sleep studies to include restricted coverage of home sleep tests, only to detect Obstructive Sleep Apnea (OSA). The NCD confirmed coverage not only for in-lab attended polysomnography, but also for unattended sleep testing performed in or out of a sleep facility using any Type II, Type III, or Type IV monitoring devices. Sleep testing monitoring devices are classified into the following types: • Type I monitoring: Full inlaboratory polysomnography. • Type II monitoring: Comprehensive portable polysomnography with a minimum of seven channels including EEG, EOG, chin EMG, ECG or heart rate, airflow, respiratory effort, and oxygen saturation. [...]
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