The therapeutic local coverage determinations (LCDs) for home sleep testing for all four DMACs were released today. In explicit language, the LCDs eliminate HME involvement in HST. The LCDs state that only sleep physicians may be involved in the tests, thereby eliminating involvement by primary care physicians, cardiologists and other physicians. While other physicians can prescribe the tests, these physicians must defer to a sleep physician to perform the tests and interpret the results.
The LCDs state, in part, that, “For dates of service on or after September 1, 2008, all sleep tests must be interpreted by a physician who is either: 1. A diplomat of the American Board of Sleep Medicine (ABSM); or, 2. Diplomat in Sleep Medicine by a member board of the American Board of Medical Specialties (ABMS); or, 3. An active staff member of a sleep center or laboratory accredited by the American Academy of Sleep Medicine (AASM) or The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations Ð 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.”
The LCDs also provided clarification of the terms of the 12-week CPAP trial and proof of benefit. Documentation of clinical benefit is demonstrated by a “face-to-face clinical re-evaluation by the treating physician with documentation that symptoms of obstructive sleep apnea are improved; and objective evidence of adherence to use of the PAP device.”
Adherence to therapy was defined as use of CPAP therapy for more than four hours per night on 70 percent of nights during a consecutive 30-day period during the first three months of initial usage.
Physician re-evaluation must occur no sooner than the 61st day but no later than the 91st day after initiating therapy.
View the local coverage determinations for DMAC Jurisdiction A (www.medicarenhic.com/dme/medical_review/mr_lcds/mr_lcd_current/L11528_031308.shtml), DMAC Jurisdiction C (
