LCD has no bearing on at-home sleep tests

Sunday, March 2, 2008

YARMOUTH, Maine - A local coverage determination (LCD) released Feb. 14 that said home-based sleep studies are not covered under Medicare is no cause for alarm, industry leaders say.

The LCD was released by National Government Services, a CMS fiscal intermediary.

"This is not DME policy," said Dr. Paul Hughes, medical director for jurisdictions A and B, the regions covered by NGS. "This is for hospitals and docs who actually do PSTs."

The LCD is simply a quarterly update, done to update revised HCPCS codes, said Dr. Robert Hoover, medical director for Jurisdiction C.

"(The DME MACs) are in the middle of that process right now," he said. "In the next week to 10 days, the MACs will release our revised policies and the CPAP is still going to say facility-based testing is the way to go."

That's because CMS has not yet released its final decision on whether to cover at-home based sleep tests. The decision, expected March 13, will likely favor the proposal.

Until then, local coverage policy cannot be updated, said Dr. Hughes.

"Until the rules change, the rules are what they are," he said.

The LCD states: "For a study to be reported as a polysomnogram, sleep must be recorded and staged and must be attended. Sleep studies should be performed in a hospital, sleep laboratory or by an Independent Diagnostic Testing Facility that is supervised by a physician trained in analyzing and interpreting the recordings and should be attended by a trained technologist. Sleep studies performed in the home are not covered."

"You will see an NCD in March that will most likely have a July 1 or Oct. 1 effective date (for at-home sleep tests), so when we are putting out our next revised policy we will again have to revise it depending on what the NCD says," said Hoover.