LCD Reference Article Article

Accreditation and Credentialing Requirements for Polysomnography LCD L36593

A55958

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
A55958
Original ICD-9 Article ID
Not Applicable
Article Title
Accreditation and Credentialing Requirements for Polysomnography LCD L36593
Article Type
Article
Original Effective Date
04/05/2018
Revision Effective Date
03/07/2024
Revision Ending Date
N/A
Retirement Date
N/A

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 © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the 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

Revision effective date: 

For services performed on or after 07/01/2018

Accreditation and credentialing requirements:

Please be aware of the following changes to accreditation and credentialing requirements:

The related Polysomnography LCD sets forth the following standards for sleep centers that perform the technical component (TC) of polysomnography (PSG) and sleep testing (including home sleep testing):

1. The sleep center or laboratory must maintain documentation on file that indicates it is accredited by either: 

  • the American Academy of Sleep Medicine (AASM), or

  • the Accreditation Commission for Health Care (ACHC), or 

  • the Ambulatory Care Accreditation Program of the Joint Commission 

This documentation must be available on request. The AASM, ACHC, or Joint Commission accreditation applies to the hospital and freestanding facilities (including sleep clinics that are part of a physician’s office, and all other non-hospital-based facilities where sleep studies are performed. Diagnostic testing performed in an Independent Diagnostic Testing Facility (IDTF) must follow the supervision and credentialing guidelines set forth by CMS and/or this A/B MAC.

The sleep laboratory or testing facility must be affiliated with a hospital or be under the direction and control of a physician (MD/DO) who meets 1 of the following requirements, even though the diagnostic test may be performed in the absence of direct physician supervision. The raw data from all sleep tests must be reviewed and the tests must be interpreted by a physician who meets at least 1 of the following requirements:  

    • Certification in Sleep Medicine by the American Board of Sleep Medicine (ABSM) or by a member board of either the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)  

    • A completed fellowship in sleep medicine through an Accreditation Council for Graduate Medical Education (ACGME)–accredited program. Following the completed fellowship, certification in sleep medicine is completed within 2 examination cycles through the ABSM or a member board of either the ABMS or the AOA

Sleep centers in Jurisdiction M have been subject to these regulations since the implementation of the LCD on October 1, 2015 and similar regulations that appeared in previous versions of the Polysomnography LCD.

 

Sleep centers in Jurisdiction J prior to February 26, 2018 were not required to meet similar standards by the previous contractor. All sleep centers in Jurisdiction J must now obtain accreditation by 1 of the 3 organizations listed above by July 1, 2018 in order to continue to render services to Medicare beneficiaries and submit claims to this A/B MAC.

 

Revision effective date: 

For services performed on or after 10/01/2018

2. As noted above in section 1, and as of October 1, 2018, outpatient sleep centers affiliated with a hospital, which is currently accredited by the Joint Commission (formerly JCAHO) through the hospital’s accreditation are required to have ambulatory care accreditation for the sleep center in order to continue to render services to Medicare beneficiaries and submit claims to this A/B MAC.

3. There is a new physician-credentialing standard published by the Joint Commission (formerly JCAHO) for ambulatory care organizations providing sleep center services that reduces quality variation and aligns credentialing requirements for all sleep testing facilities defined by the Polysomnography LCD. Specifically, as of January 1, 2018, the Joint Commission requires that organizations verify that physicians have at least 1 of the following qualifications before granting initial or revised privileges to physicians responsible for interpreting sleep studies:  

    • Certification in Sleep Medicine by the ABSM or by a member board of either the ABMS or the AOA

      OR

    • A completed fellowship in sleep medicine through an ACGME–accredited program. Following the completed fellowship, certification in sleep medicine is completed within 2 examination cycles through the ABSM or a member board of either the ABMS or the AOA.

The above language is not a new requirement under the related Polysomnography LCD. Since its implementation on October 1, 2015, the related LCD has required and continues to require, regardless of the standards put forth by any of the 3 listed accrediting organizations, that the sleep laboratory or testing facility be affiliated with a hospital or be under the direction and control of a physician (MD/DO) who meets 1 of the above requirements. The raw data from all sleep tests must be reviewed and the tests must be interpreted by a physician who meets at least 1 of the above requirements. This documentation must be available upon request. Please review the related LCD for complete information regarding polysomnography testing and billing requirements.

Response To Comments

Number Comment Response
1
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

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all 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
03/07/2024 R2

Acronyms were inserted where appropriate and formatting and typographical errors were corrected throughout the article.

10/13/2022 R1

Under Article Text subsection Accreditation and credentialing requirements verbiage in point #2 was revised to read “As noted in section 1, and as of October 1, 2018, outpatient sleep centers affiliated with a hospital, which is currently accredited by the Joint Commission (formerly JCAHO) through the hospital’s accreditation are required to have ambulatory care accreditation for the sleep center in order to continue to render services to Medicare beneficiaries and submit claims to Palmetto GBA.” Removed subsection Bibliography and source as it is no longer accessible.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L36593 - Polysomnography
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
02/28/2024 03/07/2024 - N/A Currently in Effect You are here
10/03/2022 10/13/2022 - 03/06/2024 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Polysomnography