The Centers for Medicare & Medicaid Services (CMS) announced Dec. 14 that it is proposing to change its national coverage determination (NCD) to include payment for CPAP equipment when the sleep apnea diagnosis is based on results from home sleep testing (HST).
“We are proposing that the use of CPAP will be covered when diagnosed using a clinical evaluation and PSG (polysomnography) performed in a sleep laboratory,” said CMS in the proposed decision memo. “In addition, we are proposing to expand coverage of CPAP to include those beneficiaries with a diagnosis of CPAP made using a combination of a clinical evaluation and unattended home sleep monitoring using a Type II, III or IV device.”
To read the entire proposed decision memo, go to www.cms.hhs.gov/mcd/viewdraftdecisionmemo.asp?id=204.
Should CMS decide to recognize results from home sleep testing (HST), respiratory providers could benefit from a surge in newly identified sleep apnea patients, since the National Sleep Foundation says up to 85 percent of such patients are currently undiagnosed. A major reason for patients’ failure to undergo testing is thought to be their reluctance to be monitored in a sleep lab.
Providers could also benefit from being able to sell both the HST diagnostic equipment and the therapeutic equipment to treat the sleep disorder.
In addition to recognizing HST, the decision memo included a number of other proposals, including the deletion of “the current distinct requirements that an individual have moderate to severe OSA (to qualify for CPAP coverage) and that surgery is a likely alternative because these terms are not sufficiently precise” and modifying “the criteria for a positive sleep study to remove the requirement for a minimum two hours of continuous recorded sleep and instead recognize shorter periods of continuous recorded sleep if the total number of recorded events during that shorter period is at least the number of events that would have been required in a two hour period.”
CMS is now taking public comments, with the final rule due in March.