LCD Reference Article Response To Comments Article

Response to Comments: Polysomnography and Other Sleep Studies (L36839)

A55381

Expand All | Collapse All
Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A55381
Original ICD-9 Article ID
Not Applicable
Article Title
Response to Comments: Polysomnography and Other Sleep Studies (L36839)
Article Type
Response to Comments
Original Effective Date
02/16/2017
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text
This article summarizes the comments WPS received for Draft Local Coverage Determinations (LCD) Polysomnography and Other Sleep Studies, DL36839. Thank you for the comments.

Response To Comments

Number Comment Response
1 The American Academy of Sleep Medicine (AASM) scoring criteria for hypopnea is 3% and “CMS" has 4% proposed. It would be beneficial to all if the same definition or scoring criteria was used by all insurances. Also A/B and DME contractors should be consistent in wording and add history of A-fib, supraventricular tachycardia. Adherence criteria and requalifying for DME is inconsistent and costly. The policy is written to be consistent with the Durable Medical Equipment (DME) and National Coverage Determination (NCDs) policies. And A/B MAC does not set DME rules or policies.
2 Inquiry as to why new policy was written with current sleep policy. Changes have been made to match the national Durable Medical Equipment (DME) policy. Often, non-accredited people are billing the federal government for services, and sleep studies are a major issue reported by OIG and law enforcement. The policy seeks to clarify which services qualify as sleep studies, what providers can order and perform them, and seeks to more clearly define home sleep testing.
3 Why requirement if patient doesn’t proceed with treatment within 90 days of study must have a face to face with PCP to order another diagnostic sleep study before treatment can be again initiated, or patient discontinued sleep apnea treatment, more than 60 days, required to do new face to face visit with PCP to order new diagnostic sleep study before treatment can proceed. This question submitted is in reference to the requirements of the DME L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea and this is addressed by DME and not by our MAC LCD.
4 Many hospitals are choosing to be accredited by DNV-GL Healthcare division. WPS has specifically included DNV-GL on other LCDs, such as: L35755, L35751 L35761. Would you please include DNV-GL as an approved accrediting body for DL 36839? DNV GL - Healthcare has formed an alliance with the Accreditation Commission for Health Care (ACHC). WPS does have ACHC as a credentialing option. WPS does not have plans to add DNV-GL.
5 Several templated emails were received wondering why hospitals have to follow the same credentialing options as sleep centers. Some studies are performed by the hospital staff themselves and other hospitals have contracted out with sleep groups to do the work. We do not feel that these are sleep “centers” and this LCD should not apply to these locations. We feel the policy language is unclear and confusing to hospitals who have contracted with accredited Sleep Disorder Clinics to perform sleep studies at a hospital. Hospitals are not Sleep Disorder Clinics and are not defined as such under this policy. Medicare has a defined benefit for Polysomnography and other sleep studies. Every attempt was made to write the LCD according to the benefits as described in the Medicare Manual, the National Coverage Determinations and the Durable Medical Equipment MAC LCD. Hospitals are not excluded from the requirement to be credentialed for sleep studies to be performed at their site. All sites and locations must be credentialed. WPS believes the final draft is clear that any site other than the patient’s home must be credentialed.
N/A

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L36839 - Polysomnography and Other Sleep Studies
Related National Coverage Documents
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
12/19/2016 02/16/2017 - N/A Currently in Effect You are here

Keywords

N/A