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Sleep Testing for Obstructive Sleep Apnea (OSA)

Previously, although CPAP was nationally covered for beneficiaries with OSA if diagnosed with specific tests, coverage of the tests themselves was left to local contractor discretion. As a result of this recent NCD, effective for claims with dates of service on and after March 3, 2009, Medicare will allow for coverage of the sleep testing devices, specifically: Type 1 PSG when the test is attended in a sleep lab facility, Type II or Type III if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility, or Type IV measuring 3 or more channels, one of which is airflow, if
performed unattended in or out of a sleep lab facility or attended in a sleep lab facility. This revision is an NCD. NCDs are binding on all carriers, FIs, QIOs, QICs, the Medicare appeals council, and ALJs (see 42 CFR 405.1060(a)(4)(2005)). An NCD that expands coverage is also binding on an MA organization. In addition, an ALJ may not review an NCD (1869(f)(1)(A)(i) of the Act)

Download the Guidance Document

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: July 10, 2009

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.