Wiki HST - REI rules DME LCD for CGS

Garndt14

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Does anyone out there have any knowledge on CGS Medicare and the understanding of REI versus AHI or RDI?
My physicians are doing HST and recording the REI not AHI and I am getting push back from my billers stating that REI is not accepted by CGS Medicare.
According to the LCD for CGS:

An HST is performed unattended in the beneficiary’s home using a portable monitoring device. A portable monitoring device for conducting an HST must meet one of the following criteria:

  1. Type II device – Monitors and records a minimum of seven (7) channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory movement/effort and oxygen saturation; or,

  2. Type III device – Monitors and records a minimum of four (4) channels: respiratory movement/effort, airflow, ECG/heart rate and oxygen saturation; or,

  3. Type IV device – Monitors and records a minimum of three (3) channels, one of which is airflow; or,

  4. Other - Devices that monitor and record a minimum of three (3) channels that include actigraphy, oximetry and peripheral arterial tone and for which there is substantive clinical evidence in the published peer-reviewed medical literature that demonstrates that the results accurately and reliably correspond to an AHI or RDI as defined above. This determination will be made on a device by device basis (See Appendix B for list of approved devices in this category).

I am interpreting that respiratory movement/effort would be the REI.

Why would Medicare pay for the HST portion but not allow the interpretation for CPAP?

I appreciate any insight given.

Respectfully,
Gwendolyn Arndt, CPC
 
You might want to post this question in the Pulmonary forum, Gendolyn. There may be more people looking at that forum that would have an answer for you on this since pulmonary practices usually perform sleep studies.
 
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