LCD for Polysomnography and Sleep Studies (L26428)


Contractor Information

 
Contractor Number 
NumberTypeState(s)
00130 FI IN
00131 FI IL
00160 FI KY
00332 FI OH
00450 FI WI
00452 FI MI
00453 FI VA, WV
00630 Carrier IN
00660 Carrier KY
13101 MAC CT – Part A
13102 MAC CT – Part B
13201 MAC NY – Part A
13202 MAC NY – Part B
13282 MAC NY – Part B
13292 MAC NY – Part B
Contractor Type 
Carrier
Fiscal Intermediary
MAC – Part A
MAC- Part B


LCD Information

 
LCD ID Number 
L26428 
 
LCD Title 
Polysomnography and Sleep Studies 
 
Contractor's Determination Number 
L26428 (R7) 
 
AMA CPT / ADA CDT Copyright Statement 
CPT codes, descriptions and other data only are copyright 2010 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.  
 
CMS National Coverage Policy 
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Code of Federal Regulations:

42 CFR Section 410.32 indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary's specific medical problem. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapter).

Federal Register:

Federal Register, Vol. 65, No. 68, April 7, 2000, page. 18434 is the Medicare Program Prospective Payment System for Hospital Outpatient Services Final Rule.

CMS Publications:

CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 6:
    50 Sleep Disorder Clinics
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15:
    70 Sleep Disorder Clinics
CMS Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1:
    30.4 Electrosleep Therapy
    240.4 Continuous Positive Airway Pressure (CPAP) Therapy For Obstructive Sleep Apnea (OSA) (Effective March 13, 2008)
CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 4, provides information on the Outpatient Prospective Payment System (OPPS).
 
 
Primary Geographic Jurisdiction 
NumberTypeState(s)
00130 FI IN
00131 FI IL
00160 FI KY
00332 FI OH
00450 FI WI
00452 FI MI
00453 FI VA, WV
00630 Carrier IN
00660 Carrier KY
13101 MAC CT – Part A
13102 MAC CT – Part B
13201 MAC NY – Part A
13202 MAC NY – Part B
13282 MAC NY – Part B
13292 MAC NY – Part B
 
Oversight Region
Region I, II, III, V
 
 
Original Determination Effective Date 
For services performed on or after 04/01/2008  
 
Original Determination Ending Date 
 
 
Revision Effective Date 
For services performed on or after 01/01/2011  
 
Revision Ending Date 
 
 
Indications and Limitations of Coverage and/or Medical Necessity 
Abstract:

Sleep studies and polysomnography refer to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for 6 or more hours with physician review, interpretation and report. The studies are performed to diagnose a variety of sleep disorders and to evaluate a patient's response to therapies such as continuous positive airway pressure (CPAP). Polysomnography is distinguished from sleep studies by the inclusion of sleep staging.

Sleep disorder clinics are facilities in which certain conditions are diagnosed through the study of sleep. Such clinics are for diagnosis, therapy, and research. Sleep disorder clinics may provide some diagnostic or therapeutic services that are covered under Medicare. These clinics may be affiliated either with a hospital or a freestanding facility. Whether a clinic is hospital-affiliated or freestanding, coverage for diagnostic services under some circumstances is covered under provisions of the law different from those for coverage of therapeutic services. (CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 6, Section 50).

Indications:

A - Criteria for Coverage of Diagnostic Tests

All reasonable and necessary diagnostic tests given for the medical conditions listed in subsection B are covered when the following criteria are met:
  • The clinic is either affiliated with a hospital or is under the direction and control of physicians. Diagnostic testing routinely performed in sleep disorder clinics may be covered even in the absence of direct supervision by a physician;

  • Patients are referred to the sleep disorder clinic by their attending physicians, and the clinic maintains a record of the attending physician's orders; and

  • The need for diagnostic testing is confirmed by medical evidence, e.g., physician examinations and laboratory tests.
Diagnostic testing that is duplicative of previous testing done by the attending physician to the extent the results are still pertinent is not covered because it is not reasonable and necessary under §1862(a)(1)(A) of the Act.
(CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 70).

For a study to be reported as a polysomnogram, sleep must be recorded and staged.

Polysomnography is defined to include, but is not limited to, the following:
  • A 1-4 lead electroencephalogram (EEG) to measure global neural encephalographic activity using electrodes placed on the scalp

  • Electrooculogram (EOG) to measure eye movements using electrodes placed near the outer canthus of each eye

  • A submental electromyogram (EMG) to measure submental electromyographic activity using electrodes placed over the mentalis, submentalis muscle, and/or masseter regions

  • Rhythm electrocardiogram (ECG) with two or three chest leads

  • Nasal and/or oral airflow

  • Ventilation and respiratory effort by chest-wall and abdominal movement measured using strain gauges, piezoelectric belts, inductive plethysmography, impedance or inductance pneumography, endoesophageal pressure, or by intercostal EMG

  • Gas exchange (oxygen saturation (SpO2)) by oximetry, transcutaneous monitoring, or end-tidal gas analysis

  • Extremity muscle activity, motor activity-movement using EMG

  • Body positions via mercury switches or by direct observation

  • Recordings of vibration (frequency and/or volume) may be recorded

  • Transcutaneous CO2, esophageal pH, penile tumescence, and bipolar EEG

    Sleep studies are performed in a hospital, sleep laboratory or by an Independent Diagnostic Treatment Facility that is supervised by a physician (MD/DO) trained in analyzing and interpreting the recordings and should be attended by a trained technologist. (For exception to the attendance requirement, see the section on sleep apnea below.)
B - Medical Conditions for Which Testing is Covered

Diagnostic testing is covered only if the patient has the symptoms or complaints of one of the conditions listed below. Most of the patients who undergo the diagnostic testing are not considered inpatients, although they may come to the facility in the evening for testing and then leave after testing is over. The overnight stay is considered an integral part of these tests.
    1. Narcolepsy - This term refers to a syndrome that is characterized by abnormal sleep tendencies, e.g., excessive daytime sleepiness or disturbed nocturnal sleep. Related diagnostic testing is covered if the patient has inappropriate sleep episodes or attacks (e.g., while driving, in the middle of a meal, in the middle of a conversation), amnesiac episodes, or continuous disabling drowsiness. The sleep disorder clinic must submit documentation that this condition is severe enough to interfere with the patient's well being and health before Medicare benefits may be provided for diagnostic testing. Ordinarily, a diagnosis of narcolepsy can be confirmed by three sleep naps. If more than three sleep naps are claimed,...persuasive medical evidence justifying the medical necessity for the additional test(s) [will be required]...(CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 70).
The diagnosis of narcolepsy is usually confirmed by an overnight sleep study (polysomnography) followed by a multiple sleep latency test (MSLT). MSLT involves several 20-minute nap opportunities offered at 2-hour intervals. MSLT objectively assesses sleep tendency by measuring the number of minutes it takes the patient to fall asleep. Conversely, the maintenance of wakefulness test (MWT) requires the patient to try to stay awake. MSLT is the better test for demonstration of sleep-onset REM periods, a determination that is important in establishing the diagnosis of narcolepsy. To insure validity, proper interpretation of the MSLT can only be made following a polysomnography performed on the preceding night.

The following measurements are normally required to diagnose narcolepsy:
  • Polysomnographic assessment of the quality and quantity of nighttime sleep;

  • Determination of the latency of the first REM episode;

  • MSLT; and

  • The presence of REM-sleep episodes.
Initial polysomnography and MSLT occasionally fail to identify narcolepsy. Repeat polysomnography may be indicated:
  • if the first study is technically inadequate due to equipment failure;

  • if the subject could not sleep or slept for an insufficient amount of time to allow a clinical diagnosis;

  • if initiation of therapy or confirmation of the efficacy of prescribed therapy is needed; or

  • if the results were inconclusive or ambiguous.
    2. Sleep Apnea - This is a potentially lethal condition where the patient stops breathing during sleep. Three types of sleep apnea have been described (central, obstructive, and mixed). The nature of the apnea episodes can be documented by appropriate diagnostic testing. Ordinarily, a single polysomnogram and electroencephalogram (EEG) can diagnose sleep apnea. If more than one such testing session is claimed,...persuasive medical evidence justifying the medical necessity for the additional tests [will be required]...(CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 70).
CMS' NCD on Sleep Testing for Obstructive Sleep Apnea (OSA) specifies which devices may be used to make the diagnosis of sleep apnea:

1. Type I PSG is covered when used to aid the diagnosis of OSA in beneficiaries who have clinical signs and symptoms indicative of OSA if performed attended in a sleep lab facility.

2. Type II or Type III sleep testing devices are covered when used to aid the diagnosis of OSA in beneficiaries who have clinical signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.

3. Type IV sleep testing devices measuring three or more channels, one of which is airflow, are covered when used to aid the diagnosis of OSA in beneficiaries who have signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.

4. Sleep testing devices measuring three or more channels that include actigraphy, oximetry, and peripheral arterial tone, are covered when used to aid the diagnosis of OSA in beneficiaries who have signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility. (CMS Publication 100-03, Medicare National Coverage Determinations, Chapter 1, Section 240.4.1) (Effective March 3, 2009)


The diagnosis of sleep apnea may be made using the following modalities:
    1. polysomnography (PSG) performed in a sleep laboratory; or
    2. unattended home sleep monitoring device of Type II; or
    3. unattended home sleep monitoring device of Type III; or
    4. unattended home sleep monitoring device of Type IV, measuring at least three channels (CMS Publication 100-03, Medicare National Coverage Determinations, Chapter 1, Section 240.4) ( Effective March 13, 2008)
    Sleep apnea may be due to an occlusion of the airway (obstructive apnea), absence of respiratory effort (central sleep apnea) or a combination of these factors (mixed sleep apnea).

    (OSA) may be caused by one of the following:
    • Reduced upper airway caliber due to obesity;

    • Adenotonsillar hypertrophy;

    • Mandibular deficiency;

    • Macroglossia;

    • Upper airway tumor;

    • Excessive pressure across the collapsible segment of the upper airway;

    • Activity of the muscles of the upper airway insufficient to maintain patency.
    For patients with severe and unambiguous obstructive sleep apnea, the initiation of treatment with nasal CPAP may be incorporated into the diagnostic study night. A "split-night" study (initial diagnostic polysomnogram confirming the diagnosis of obstructive sleep apnea followed by CPAP titration during polysomnography on the same night) may be an alternative to one full night of diagnostic polysomnography followed by a second night of titration as long as:
    • CPAP titration is carried out for more than 3 hours; and

    • Polysomnography or HST documents that CPAP eliminates or nearly eliminates the respiratory events during REM and NREM sleep.

      Repeat polysomnography or HST for diagnosing sleep apnea requires documentation justifying the medical necessity for the repeated test. Repeat polysomnography may be indicated:

    • if the first study is technically inadequate due to equipment failure;

    • if the subject could not sleep or slept for an insufficient amount of time to allow a clinical diagnosis;

    • if the results were inconclusive or ambiguous; or

    • if initiation of therapy or confirmation of the efficacy of prescribed therapy is needed.
    Follow-up polysomnography or HST is not routinely indicated for patients treated with CPAP whose symptoms continue to be resolved with CPAP treatment. Follow-up polysomnography may be indicated, however, under the following circumstances:
    • After substantial weight loss has occurred in patients on CPAP for treatment of sleep-related breathing disorders to ascertain whether CPAP is still needed at the previously titrated pressure;

    • After substantial weight gain has occurred in patients previously treated with CPAP successfully, who are again symptomatic despite the continued use of CPAP, to ascertain whether pressure adjustments are needed; or

    • When clinical response is insufficient or when symptoms return despite a good initial response to treatment with CPAP.
      3. Parasomnia - Parasomnias are a group of conditions that represent undesirable or unpleasant occurrences during sleep. Behavior during these times can often lead to damage to the surroundings and injury to the patient or to others. Parasomnia may include conditions such as sleepwalking, sleep terrors, and rapid eye movement (REM) sleep behavior disorders. In many of these cases, the nature of these conditions may be established by careful clinical evaluation. Suspected seizure disorders as possible cause of the parasomnia are appropriately evaluated by standard or prolonged sleep EEG studies. In cases where seizure disorders have been ruled out and in cases that present a history of repeated violent or injurious episodes during sleep, polysomnography may be useful in providing a diagnostic classification or prognosis. (CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 70).
    Normally, a clinical history, neurologic examination, and routine EEG obtained while the patient is awake and asleep are often sufficient to establish the diagnosis and permit the appropriate treatment of sleep-related epilepsy. In addition, common, uncomplicated, non-injurious parasomnias, such as typical disorders of arousal, nightmares, enuresis, somniloquy, and bruxism can usually be diagnosed by clinical evaluation alone.

    Polysomnography is indicated to provide a diagnostic classification or prognosis when both of the following exist:
    • When the clinical evaluation and results of standard EEG have ruled out a seizure disorder; and

    • In cases that present a history of episodes during sleep that result in harm to the patient or others.
    When polysomnography is performed for the diagnosis of parasomnias, the following measurements are obtained:
    • Sleep-scoring channels (EEG, EOG, chin EMG);

    • EEG using an expanded bilateral montage;

    • EMG for body movements;

    • Audiovisual recording; and

    • Documented technologist observations.
    C - Polysomnography for Chronic Insomnia Is Not Covered.

    Evidence at the present time is not convincing that polysomnography in a sleep disorder clinic for chronic insomnia provides definitive diagnostic data or that such information is useful in patient treatment or is associated with improved clinical outcome. The use of polysomnography for diagnosis of patients with chronic insomnia is not covered under Medicare because it is not reasonable and necessary under §1862(a)(1)(A) of the Act.
    (CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 70).

    D. Coverage of Therapeutic Services.

    Sleep disorder clinics may at times render therapeutic as well as diagnostic services. Therapeutic services may be covered in a hospital outpatient setting or in a freestanding facility provided they meet pertinent requirements for the particular type of services and are reasonable and necessary for the patient, and are performed under the direct personal supervision of a physician.
    (CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 70).

    Limitations:

    Diagnostic testing that is duplicative of previous sleep testing done by the attending physician to the extent that the previous results are still pertinent is not covered, because it is not reasonable and necessary if there have been no significant clinical changes in the patient's medical history since the previous study.

    Sleep testing performed using an unattended portable monitor (home sleep testing (HST)) for the diagnosis of obstructive sleep apnea must adhere to the guidelines specified in "Clinical Guidelines for the Use of Unattended Portable Monitors in the Diagnosis of Obstructive Sleep Apnea in Adult Patients" ( Journal of Clinical Sleep Medicine, Vol. 3, No. 7, 2007). If discrepancies exist between these guidelines and this LCD, the parameters in this LCD take precedence. HST is covered only for the diagnostic study of OSA and for no other indications.

    HCPCS codes G0398, G0399, and G0400 and CPT codes 95800, 95801 and 95806 (unattended sleep study) by definition involves the absence of a technologist. Unattended sleep studies must meet the narrative definition of the codes. G0400, Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels, must measure respiratory movement, airflow, and oxygen saturation. Effective for dates of service on or after 01/01/2011, CPT codes 95800 and 95801 have been added.

    HST is not covered for patients with certain medical comorbidities, including:
    • Moderate to severe pulmonary disease (e.g., patients on oxygen or regular bronchodilator use)
    • Neuromuscular disease affecting muscles of respiration
    • Congestive heart failure
    • Suspicion of the presence of other sleep disorders.
    Polysomnography, HST and MSLT are not covered in the following situations:
    • For the diagnosis of patients with chronic insomnia;

    • To preoperatively evaluate a patient for laser-assisted uvulopalatopharyngoplasty without clinical evidence that obstructive sleep apnea is suspected;

    • To diagnose chronic lung disease (nocturnal hypoxemia in patients with chronic, obstructive, restrictive or reactive lung disease is usually adequately evaluated by oximetry; however, if the patient's sign/symptoms suggest a diagnosis of obstructive sleep apnea, polysomnography may be considered medically necessary);

    • In cases where seizure disorders have not been ruled out;

    • In cases of typical, uncomplicated and non-injurious parasomnias when the diagnosis is clearly delineated;

    • For patients with epilepsy who have no specific complaints consistent with a sleep disorder;

    • For patients with symptoms suggestive of periodic limb movement disorder or restless leg syndrome unless symptoms are suspected of being related to a covered indication;

    • For the diagnosis of insomnia related to depression;

    • For the diagnosis of circadian rhythm sleep disorders (i.e., rapid time-zone change [jet lag], shift-work sleep disorder, delayed sleep phase syndrome, advanced sleep phase syndrome, and non-24 hour sleep/wake disorder).
    Other Comments:

    For claims submitted to the fiscal intermediary or Part A MAC: this coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated National Government Services to process their claims.

    Bill type codes only apply to providers who bill these services to the fiscal intermediary or Part A MAC. Bill type codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

    Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes.

    For all non-hospital based facilities, the facility must have on file documentation that it is in compliance with the criteria set by the American Sleep Disorders Association or the American Academy of Sleep Medicine. Failure to supply such documentation may result in denial of the claim. Medicare does not cover sleep studies performed in mobile sleep laboratories.

    The sleep laboratory or testing facility must be affiliated with a hospital or be under the direction and control of a physician (MD/DO), even though the diagnostic test may be performed in the absence of direct physician supervision. The laboratory physician director must be:
    • Board-certified in sleep medicine (ABSM, i.e., Diplomate of, or board-eligible for, the American Board of Sleep Medicine; or
    • Diplomate or board-eligible for an American Board of Medical Specialties (ABMS) approved board; or
    • Completed residency or fellowship training by an ABMS member board and has completed all the requirements for subspecialty certification in sleep medicine except the examination itself, and only until the time of reporting of the first examination for which the physician is eligible; or
    • 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 (JCAHO)
    HST scoring must be performed by an individual certified by the Board of Registered Polysomnographic Technologists as a Registered Polysomnographic Technologist (RPSGT), or equivalent, or by a polysomnographic technician under the supervision of a RPSGT, or equivalent. RPSGTs and polysomnographic technicians must meet the standards for such individuals promulgated by the American Academy of Sleep Medicine Standards for Accreditation of Laboratories for Sleep Related Breathing Disorders, and be licensed or certified by the state in which they practice, if such licensure or certification exists. The laboratory physician must review the entire raw data recording for every patient studied.

    The above credentialing information must be documented and available upon request. 
     


    Coding Information

     
    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 policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

    012x Hospital Inpatient (Medicare Part B only)
    013x Hospital Outpatient
    021x Skilled Nursing - Inpatient (Including Medicare Part A)
    085x Critical Access Hospital
     
     
    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 policy 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 policy should be assumed to apply equally to all Revenue Codes.

    Revenue codes only apply to providers who bill these services to the fiscal intermediary or Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

    Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.

    0519 Clinic - Other Clinic
    0740 EEG (Electroencephalogram) - General Classification
    0920 Other Diagnostic Services - General Classification
    0929 Other Diagnostic Services - Other Diagnostic Service
    0960 Professional Fees - General Classification
    0976 Professional Fees - Respiratory Therapy
    0982 Professional Fees - Outpatient Services
    0983 Professional Fees - Clinic
    0985 Professional Fees - EKG
    0987 Professional Fees - Hospital Visit
    0988 Professional Fees - Consultation
     
     
    CPT/HCPCS Codes 

    95800 SLEEP STUDY, UNATTENDED, SIMULTANEOUS RECORDING; HEART RATE, OXYGEN SATURATION, RESPIRATORY ANALYSIS (EG, BY AIRFLOW OR PERIPHERAL ARTERIAL TONE), AND SLEEP TIME
    95801 SLEEP STUDY, UNATTENDED, SIMULTANEOUS RECORDING; MINIMUM OF HEART RATE, OXYGEN SATURATION, AND RESPIRATORY ANALYSIS (EG, BY AIRFLOW OR PERIPHERAL ARTERIAL TONE)
    95805 MULTIPLE SLEEP LATENCY OR MAINTENANCE OF WAKEFULNESS TESTING, RECORDING, ANALYSIS AND INTERPRETATION OF PHYSIOLOGICAL MEASUREMENTS OF SLEEP DURING MULTIPLE TRIALS TO ASSESS SLEEPINESS
    95806 SLEEP STUDY, UNATTENDED, SIMULTANEOUS RECORDING OF, HEART RATE, OXYGEN SATURATION, RESPIRATORY AIRFLOW, AND RESPIRATORY EFFORT (EG, THORACOABDOMINAL MOVEMENT)
    95807 SLEEP STUDY, SIMULTANEOUS RECORDING OF VENTILATION, RESPIRATORY EFFORT, ECG OR HEART RATE, AND OXYGEN SATURATION, ATTENDED BY A TECHNOLOGIST
    95808 POLYSOMNOGRAPHY; SLEEP STAGING WITH 1-3 ADDITIONAL PARAMETERS OF SLEEP, ATTENDED BY A TECHNOLOGIST
    95810 POLYSOMNOGRAPHY; SLEEP STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP, ATTENDED BY A TECHNOLOGIST
    95811 POLYSOMNOGRAPHY; SLEEP STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP, WITH INITIATION OF CONTINUOUS POSITIVE AIRWAY PRESSURE THERAPY OR BILEVEL VENTILATION, ATTENDED BY A TECHNOLOGIST
    G0398 HOME SLEEP STUDY TEST (HST) WITH TYPE II PORTABLE MONITOR, UNATTENDED; MINIMUM OF 7 CHANNELS: EEG, EOG, EMG, ECG/HEART RATE, AIRFLOW, RESPIRATORY EFFORT AND OXYGEN SATURATION
    G0399 HOME SLEEP TEST (HST) WITH TYPE III PORTABLE MONITOR, UNATTENDED; MINIMUM OF 4 CHANNELS: 2 RESPIRATORY MOVEMENT/AIRFLOW, 1 ECG/HEART RATE AND 1 OXYGEN SATURATION
    G0400 HOME SLEEP TEST (HST) WITH TYPE IV PORTABLE MONITOR, UNATTENDED; MINIMUM OF 3 CHANNELS
     
     
    ICD-9 Codes that Support Medical Necessity 
    It is the responsibility of the provider to code to the highest level specified in the ICD-9-CM (e.g., to the fourth or fifth digit). The correct use of an ICD-9-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

    For sleep studies done due to sleep apnea: Use CPT codes 95800, 95801, 95806-95811, HCPCS codes G0398, G0399, G0400 and applicable ICD-9-CM codes:

    327.10 ORGANIC HYPERSOMNIA, UNSPECIFIED
    327.11 IDIOPATHIC HYPERSOMNIA WITH LONG SLEEP TIME
    327.12 IDIOPATHIC HYPERSOMNIA WITHOUT LONG SLEEP TIME
    327.20 ORGANIC SLEEP APNEA, UNSPECIFIED
    327.21 PRIMARY CENTRAL SLEEP APNEA
    327.23 OBSTRUCTIVE SLEEP APNEA (ADULT) (PEDIATRIC)
    327.24 IDIOPATHIC SLEEP RELATED NON OBSTRUCTIVE ALVEOLAR HYPOVENTILATION
    327.25 CONGENITAL CENTRAL ALVEOLAR HYPOVENTILATION SYNDROME
    327.26 SLEEP RELATED HYPOVENTILATION/HYPOXEMIA IN CONDITIONS CLASSIFIABLE ELSEWHERE
    327.27 CENTRAL SLEEP APNEA IN CONDITIONS CLASSIFIED ELSEWHERE
    327.29 OTHER ORGANIC SLEEP APNEA
    780.51 INSOMNIA WITH SLEEP APNEA, UNSPECIFIED
    780.53 HYPERSOMNIA WITH SLEEP APNEA, UNSPECIFIED
    780.54 HYPERSOMNIA, UNSPECIFIED
    780.57 UNSPECIFIED SLEEP APNEA
    786.04 CHEYNE-STOKES RESPIRATION
    For sleep studies done due to parasomnias: Use CPT codes 95807-95811 and applicable ICD-9-CM codes:
    307.46 SLEEP AROUSAL DISORDER
    307.47 OTHER DYSFUNCTIONS OF SLEEP STAGES OR AROUSAL FROM SLEEP
    327.40 ORGANIC PARASOMNIA, UNSPECIFIED
    327.41 CONFUSIONAL AROUSALS
    327.42 REM SLEEP BEHAVIOR DISORDER
    327.51 PERIODIC LIMB MOVEMENT DISORDER
    780.56 DYSFUNCTIONS ASSOCIATED WITH SLEEP STAGES OR AROUSAL FROM SLEEP
    For sleep studies done due to narcolepsy: Use CPT codes 95807-95811 plus 95805 and applicable ICD-9-CM codes:
    307.48 REPETITIVE INTRUSIONS OF SLEEP
    347.00 NARCOLEPSY, WITHOUT CATAPLEXY
    347.01 NARCOLEPSY, WITH CATAPLEXY
    347.10 NARCOLEPSY IN CONDITIONS CLASSIFIED ELSEWHERE, WITHOUT CATAPLEXY
    347.11 NARCOLEPSY IN CONDITIONS CLASSIFIED ELSEWHERE, WITH CATAPLEXY
     
     
    Diagnoses that Support Medical Necessity 
    Not applicable 
     
    ICD-9 Codes that DO NOT Support Medical Necessity 
    Not applicable
     
     
    ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation 
     
     
    Diagnoses that DO NOT Support Medical Necessity 
    Not applicable 


    General Information

     
    Documentation Requirements 
    The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

    Patients that receive sleep testing must have a face-to-face clinical evaluation by the treating physician prior to the sleep test. The physician shall document the face-to-face clinical evaluation and re-evaluation in a detailed narrative note in their charts in the format that they use for other entries. For the initial evaluation, the report would commonly document pertinent information about the following elements, but may include other details. Each element would not have to be addressed in every evaluation.

    History
    • Signs and symptoms of sleep disordered breathing including snoring, daytime sleepiness, observed apneas, choking or gasping during sleep, morning headaches;
    • Duration of symptoms
    • Validated sleep hygiene inventory such as the Epworth Sleepiness Scale
    Physical Exam
    • Focused cardiopulmonary and upper airway system evaluation
    • Neck circumference
    • Body mass index (BMI)
    For services to be reported as sleep studies or polysomnography, the patient must sleep six or more hours, with physician review, interpretation and report of the study. ( Current Procedural Terminology (CPT) 2004)

    The following minimal information must be included in the sleep disorders evaluation report:
    • Parameters monitored;

    • Start time and duration of day/night of study;

    • Total sleep time, sleep efficiency, number/duration of awakenings;

    • For tests involving sleep staging: time and percent time spent in each stage;

    • For tests monitoring sleep latency or maintenance of wakefulness testing: latency to both NREM and REM sleep;

    • Individual sub-test sleep latencies, mean sleep latency, and the number of REM occurrences on MSLT.

    • Respiratory patterns including type (central/obstructive/periodic), number and duration, effect on oxygenation, sleep stage/body position relationship, and response to any diagnostic/therapeutic maneuvers;

    • Cardiac rate/rhythm and any effect of sleep disordered breathing on EKG,

    • Detailed behavioral observations; and

    • EEG or EMG abnormalities.
    The patient must be referred to the clinic by the attending/treating physician. The referring physician's order for the testing must be kept in the medical record. Sleep testing must be conducted by an entity that qualifies as a Medicare provider of sleep testing and is in compliance with all applicable state regulatory requirements. The patient who undergoes HST must receive, prior to the test, adequate instruction on how to properly apply a portable sleep monitoring device. This instruction must be provided by the provider conducting the HST.

    The sleep disorder clinic must maintain and provide to Medicare, when requested, sufficient documentation that narcolepsy is severe enough to interfere with the patient's well being and health before Medicare benefits are provided for diagnostic testing.

    If more than two nights of testing are performed, documentation justifying the medical necessity for the additional test(s) must be available in the patient's medical record. 
     
    Appendices 

      Apnea - cessation or near cessation of respiration for a minimum of 10 seconds.

      Apnea-Hypopnea Index - the average number of episodes of apnea and hypopnea per hour without the use of a positive airway pressure device; also referred to as the respiratory disturbance index.

      Cataplexy - a condition in which there are abrupt attacks of muscular weakness and hypotonia triggered by an emotional stimulus such as mirth, anger, fear or surprise.

      Hypersomnolence - need for excessive amounts of sleep and sleepiness when awake.

      Hypnagogic Hallucinations - vivid dream-like experiences at the time of falling asleep which the patient cannot distinguish from reality.

      Hypopnea - an abnormal respiratory event lasting at least 10 seconds with at least a 30% reduction in thoracoabdominal movement or airflow as compared to baseline, and with at least a 4% oxygen desaturation.

      Insomnia - the complaint of inadequate sleep. Insomnia is subdivided into difficulty falling asleep, frequent or sustained awakenings, early morning awakenings, or persistent sleepiness despite sleep of adequate duration.

      Multiple Sleep Latency Test (MSLT) - a tool used to assess daytime functioning as an index of the adequacy of sleep. MSLT involves repeated measurement of sleep latency (time to onset of sleep) under standardized conditions during a day following quantified nocturnal sleep. The average latency across four to six tests (administered every 2 hours across the waking day) is taken as an objective measure of daytime sleep tendency. (Note: MSLT studies for suspected narcolepsy usually consist of up to three naps.)

      Parasomnia - a behavior disorder during sleep that is associated with brief or partial arousals but not with marked sleep disruption or impaired daytime alertness.

      Periodic Limb Movement Disorder - also known as myoclonus and is characterized by involuntary, stereotypic, repetitive limb movements that may occur during sleep and usually involve the legs. This causes frequent arousals and leads to insomnia or excessive daytime sleepiness.

      REM Sleep Behavior Disorder - a rare parasomnia that primarily afflicts men of middle age or older, many of whom have a history of prior neurological disease. Presenting symptoms are of violent behavior during sleep reported by a bed partner. In contrast to sleepwalking, injury to patient or bystander is common, and upon awakening, the patient reports vivid, often unpleasant dream imagery.

      Respiratory-Arousal Index - the total number of arousals per hour of sleep from apneas, hypopneas, and periodic increases in respiratory effort. Respiratory arousals may occur in the absence of sleep apneas or hypopneas but in association with snoring due to increased upper airway resistance, a condition called upper airway resistance syndrome (UARS).

      Respiratory disturbance index (RDI) - the number of apneas, hypopneas and respiratory event related arousals (RERAs) per hour of sleep. The apnea-hypopnea index (AHI) is the number of apneas and hypopneas per hour of sleep. When a portable monitor is used that does not measure sleep, the RDI refers to the number of apneas plus hypopneas per hour of recording.

      Restless Leg Syndrome - a neurologic disorder characterized by disagreeable leg sensations that usually occur at rest or before sleep and are alleviated by motor activity. Patients with this dyssomnia report an irresistible urge to move their legs when awake and inactive, especially when lying in bed just prior to sleep. This interferes with the ability to fall asleep. They report a creeping or crawling sensation deep within the calves or thighs, or sometimes even in the upper limbs, that is only relieved briefly by movement, particularly walking. Nearly all patients with restless legs also experience periodic limb movement disorder during sleep, although the reverse is not the case.

      Sleep Bruxism - an involuntary, forceful, grinding of the teeth during sleep that affects 10-20 percent of the population. The patient is usually aware of the problem with a typical age of onset at 17-20 years of age with spontaneous remission usually occurring by age 40.

      Sleep Enuresis - bedwetting. Before age five or six, nocturnal enuresis should probably be considered a normal feature of development. The condition usually spontaneously improves at puberty, has a prevalence in late adolescence of one to three percent, and is rare in adulthood.

      Sleep paralysis - the experience of being awake but unable to move that usually occurs near sleep onset or offset and lasts a few seconds.

      Sleep Terrors - a disorder primarily occurring in children that is characterized by the child's sudden screaming and exhibition of autonomic arousal with sweating, tachycardia and hyperventilation. The individual may be difficult to arouse and rarely remembers the episode on awakening in the morning.

      Snoring - a rough, rattling, inspiratory noise produced by vibration of the pendulous palate, or sometimes of the vocal cords, during sleep or coma.

      Somnambulism - sleepwalking that is usually characterized by the carrying out of automatic motor activities that range from minor to complex.

      Somniloquy - the act of talking during sleep or in a hypnotic condition.

      Upper Airway Resistance Syndrome (UARS) - a type of sleep apnea in which the patient demonstrates heavy snoring (stridor) without true hypopnea/apnea episodes.

      Wakefulness Test - measurement of the ability to stay awake while the patient sits up in a dimly lit room (also referred to as Maintenance of Wakefulness Test (MWT)).
     
     
    Utilization Guidelines 
    If more than one testing session is performed for sleep studies for suspected sleep apnea, persuasive medical evidence justifying the medical necessity for the additional tests will be required. 
     
    Sources of Information and Basis for Decision 
    This bibliography presents those sources that were obtained during the development of this policy. National Government Services is not responsible for the continuing viability of Web site addresses listed below.

    AdminaStar Federal and other Medicare contractors' Local Coverage Determinations/Local Medical Review Policies.

    American Academy of Sleep Medicine. Assessment and management of sleep disorders in a primary care practice. Available at: http://www.asda.org/MEDSleep/Products/(RosenG)primarycare.pdf. Accessed April 2, 2002.

    American Academy of Sleep Medicine. Standards of Practice Parameters; Polysomnography. Report practice parameters for the indications for polysomnography and related procedures: An update for 2005. American Academy of Sleep Medicine Web site: http://www.aasmnet.org/PracticeParameters.aspx?cid=104. Accessed March 11, 2009.

    American Sleep Disorder Association. Practice parameters for the indications for polysomnography and related procedures. SLEEP Web site. http://www.journalsleep.org/Search.aspx. 1997. Accessed March 11, 2009.

    American Sleep Disorder Association. Practice parameters for the use of actigraphy in the clinical assessment of sleep disorders. SLEEP Web site. http://www.journalsleep.org/Search.aspx. 1995. Accessed March 11, 2009.

    American Sleep Disorder Association. Practice parameters for the use of polysomnography in the evaluation of insomnia. SLEEP Web site. http://www.journalsleep.org/Search.aspx. 1995. Accessed March 11, 2009.

    American Sleep Disorder Association. Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. SLEEP Web site. http://www.journalsleep.org/Search.aspx. 1994. Accessed March 11, 2009.

    American Thoracic Society. Indications and standards for cardiopulmonary sleep studies. ATS Web site. http://www.thoracic.org/sections/publications/statements/pages/archive/iscss-1989.html. 1989. Accessed March 10, 2009.

    American Thoracic Society/American Sleep Disorder Association. Statement on health outcomes research in sleep apnea. ATS Web site. http://www.thoracic.org/sections/publications/statements/resources/sleepap1-7.pdf. 1998. Accessed March 10, 2009.

    Collop NA, Anderson WM, Boehlecke B, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2007;3(7):737-747.

    Epworth Sleepiness Scale. Sleep Channel Web site. http://www.sleepdisorderchannel.com/epworth.shtml. Accessed March 10, 2009.

    Littner M, Hirshkowitz M, Davila D, et al. Practice parameters for the use of auto-titrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome, American Academy of Sleep Medicine report. Sleep. 2002;15:25(2):143-147.

    National Institutes of Health Consensus Development Conference Statement. HSTAT Web site. http://text.nlm.nih.gov/nih/cdc/www/78txt.html. March 26-28, 1990. Accessed March 10, 2009. 
     
    Advisory Committee Meeting Notes 
    Carrier Advisory Committee Meeting Date(s):

    Connecticut: 01/27/2009
    Indiana: 01/26/2009
    Kentucky: 01/22/2009
    New York: 01/28/2009

    This coverage determination does not reflect the sole opinion of the contractor or contractor Medical Director. Although the final decision rests with the contractor, this determination is developed in consultation with representatives from Advisory Committee members and/or from various state and local provider organizations. 
     
    Start Date of Comment Period 
    01/08/2009 
     
    End Date of Comment Period 
    02/21/2009 
     
    Start Date of Notice Period 
    01/01/2011 
     
    Revision History Number 
    R7 
     
    Revision History Explanation 
    R7 (effective 01/01/2011): Based on the annual HCPCS update, CPT codes 95800 and 95801 have been added to the third paragraph in the “Limitations” section of the LCD, added to the “CPT/HCPCS Codes” section and to the “ICD-9 Codes that Support Medical Necessity” section for sleep studies done due to sleep apnea effective for dates of service on or after 01/01/2011. Minor changes were made to reflect current template language. No notice required and none given.

    R6 (effective 03/01/2010): Information pertaining to CPAP coverage has been removed from the Indications section of the LCD. The statement explaining RDI has been moved from the “Indications” section of the LCD to the Glossary in the “Appendices” section of the LCD and the following statement has been added to the explanation: “When a portable monitor is used that does not measure sleep, the RDI refers to the number of apneas plus hypopneas per hour of recording.” In the Indications section of the LCD the following bulleted language, nasal and/or oral airflow via mercury switches or by direct observation, has been revised to, nasal and/or oral airflow. Minor revisions have been made to reflect current template language. No notice required and none given.

    (R5) (Effective 10/01/2009: Based on Change Request (CR) 6534, Sleep Testing for Obstructive Sleep Apnea (OSA), CMS' NCD on Sleep Testing for Obstructive Sleep Apnea (OSA) has been revised to specify which devices may be used to make the diagnosis of sleep apnea:

      1. Type I PSG is covered when used to aid the diagnosis of OSA in beneficiaries who have clinical signs and symptoms indicative of OSA if performed attended in a sleep lab facility.
      2. Type II or Type III sleep testing devices are covered when used to aid the diagnosis of OSA in beneficiaries who have clinical signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.
      3. Type IV sleep testing devices measuring three or more channels, one of which is airflow, are covered when used to aid the diagnosis of OSA in beneficiaries who have signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.
      4. Sleep testing devices measuring three or more channels that include actigraphy, oximetry, and peripheral arterial tone, are covered when used to aid the diagnosis of OSA in beneficiaries who have signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility. (CMS Publication 100-03, Medicare National Coverage Determinations, Chapter 1, Section 240.4.1) (Effective March 3, 2009)
    The above information has been added to the "Indications" section of the LCD. "Obstructive Sleep Apena" has been removed from the following sentence; "Obstructive sleep apnea (OSA) may be caused by one of the following:" in the "Indications" section of the LCD. Although revision R5 is effective 10/01/2009, CR 6534 is effective 07/01/2009. No notice required and none given.

    (R4) (Effective 07/01/2009): Source of revision – External/Internal: The existing LCD was resubmitted to all NGS Part A and Part B jurisdictions for public and CAC comment from 01/08/2009 through 02/21/2009. This LCD has been revised to include indications, limitations and documentation requirements for sleep testing performed using an unattended portable monitor (home sleep testing (HST)) for the diagnosis of obstructive sleep apnea. CMS Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Section 240.4 has been revised to include "effective March 13, 2008" in the "CMS National Coverage Policy" section. References to Coverage Decision Memorandum for Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA) (CAG-00093R2) have been removed and replaced with revised information from CMS Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Section 240.4 based on Change Request 6048. HCPCS codes G0398, G0399, and G0400 have been added to the "CPT/HCPCS Codes" section and added to the ICD-9-CM code section for sleep studies done due to sleep apnea. The "Limitations" section has been revised to include limitations for HCPCS codes G0398, G0399 and G0400. Bill types 22X and 24X have been removed and Revenue code 0929 has been added. A definition for RDI has been added to "Item B" in the "Indications" section. The language for "split-night" studies has been clarified in the following statement: "A "split-night" study (initial diagnostic polysomnogram followed by CPAP titration during polysomnography on the same night) may be an alternative to one full night of diagnostic polysomnography followed by a second night of titration as long as:" in "Item B" in the "Indications" section. "Cardiorespiratory sleep studies" has been removed from the following paragraph: "Follow-up polysomnography, HST, or cardiorespiratory sleep studies are not routinely indicated for patients treated with CPAP whose symptoms continue to be resolved with CPAP treatment. Follow-up polysomnography or cardiorespiratory sleep studies may be indicated, however, for the following conditions:" in "Item B" in the "Indications" section. The following sources have been added to the "Sources of Information and Basis for Decision" section; Collop NA, Anderson WM, Boehlecke B, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2007;3(7):737-747 and Epworth sleepiness scale.

    06/05/2009 - In accordance with Section 911 of the Medicare Modernization Act of 2003, fiscal intermediary number 00270 is removed from this LCD/Article. Effective on this date, claims processing for New Hampshire and Vermont is performed by National Heritage Insurance Company (NHIC), the Part A/Part B MAC contractor for these states.

    05/15/2009 - In accordance with Section 911 of the Medicare Modernization Act of 2003, fiscal intermediary numbers 00180 and 00181 are removed from this LCD/Article. Effective on this date, claims processing for Maine and Massachusetts is performed by National Heritage Insurance Company (NHIC), the Part A/Part B MAC contractor for these states.

    (R3) (effective 02/01/2009): Source of revision – Internal - Minor changes were made to reflect current template language. No notice period required and none given.

    (R2) This revised LCD is effective for all National Government Services jurisdictions on July 18, 2008 with these exceptions: for Connecticut – Part B the LCD is effective on August 1, 2008; for Upstate New York – Part B, the LCD is effective on September 1, 2008; and for New York and Connecticut – Part A, the LCD is effective on November 14, 2008. For New York – Part A (contract 00308), the content of this LCD is currently in effect but the LCD will be transferred to the J-13 contract number 13201 on November 14, 2008.

    This LCD was revised to add the Jurisdiction 13 (J-13) MAC contractor numbers.

    The CMS Statement of Work for the J13 Medicare Administrative Contract (MAC) requires that the contractor retain the most clinically appropriate LCD within the jurisdiction. This NGS policy is being promulgated to the J13 MAC as the most clinically appropriate LCD within that jurisdiction.

    The NGS roster of LCDs has been developed under the combined experience of seven Medicare contractor medical directors. The criteria for inclusion in this roster includes areas of identified CERT errors, especially repetitive errors; high volume/high dollar/pervasive problems; patient safety issues; potential for automation; beneficiary access to new technology; implementation of NCD; narrative medical necessity parameters for medical review and provider education; and CMS/law enforcement mandates.

    (R1) - (published 05/15/2008) - in the Other Comments section the words "or in the home" have been removed to coincide with the Coverage Decision Memorandum for Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA) (CAG-0093R2) which allows payment for unattended sleep studies for OSA. Although R1 is effective 05/15/2008 the revision is effective 04/01/2008. No notice period required and none given.

    Cor#1 (published 04/01/2008 at conclusion of the Notice Period) (effective 04/01/2008): LCD revised to include information that is listed in the Coverage Decision Memorandum for Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA)(CAG-0093R2) which allows payment for unattended sleep studies for OSA. No additional comment or notice periods required and none given.

    ******************************

    The following are administrative notes entered by the Medicare Coverage Database Contractor:


    08/18/2008 - In accordance with Section 911 of the Medicare Modernization Act of 2003, fiscal intermediary number 00454 was removed from this LCD as the claims processing for American Samoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands was transitioned to Palmetto GBA, the Part A/Part B MAC contractor in these states.

    11/14/2008 - In accordance with Section 911 of the Medicare Modernization Act of 2003, fiscal intermediary number 00308 is removed from this LCD. Effective on this date, claims processing for Delaware is performed by Highmark Medicare Services, the Part A/Part B MAC contractor for this state, and the claims processing for New York and Connecticut is performed by National Government Services under the J-13 MAC contract; carrier number 00805 is removed, and claims processing for New Jersey is performed by Highmark Medicare Services, the Part A/Part B MAC contractor for this state.

    11/15/2009 - The description for CPT/HCPCS code 95806 was changed in group 1

    8/1/2010 - The description for Bill Type Code 12 was changed
    8/1/2010 - The description for Bill Type Code 13 was changed
    8/1/2010 - The description for Bill Type Code 21 was changed
    8/1/2010 - The description for Bill Type Code 85 was changed

    8/1/2010 - The description for Revenue code 0519 was changed
    8/1/2010 - The description for Revenue code 0740 was changed
    8/1/2010 - The description for Revenue code 0920 was changed
    8/1/2010 - The description for Revenue code 0929 was changed
    8/1/2010 - The description for Revenue code 0960 was changed
    8/1/2010 - The description for Revenue code 0976 was changed
    8/1/2010 - The description for Revenue code 0982 was changed
    8/1/2010 - The description for Revenue code 0983 was changed
    8/1/2010 - The description for Revenue code 0985 was changed
    8/1/2010 - The description for Revenue code 0987 was changed
    8/1/2010 - The description for Revenue code 0988 was changed

    8/1/2010 - Revenue code 0749 was deleted

    11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
    95807 descriptor was changed in Group 1
    95808 descriptor was changed in Group 1
    95810 descriptor was changed in Group 1 
     
    Reason for Change 
     
    Last Reviewed On Date 
    01/01/2011 
     
    Related Documents 
    Article(s)
    A48396 - Polysomnography and Sleep Studies – Supplemental Instructions Article
     
    LCD Attachments 
    Polysomnography and Sleep Studies Apr_08 - Comment and Response (113,332 bytes)
    Polysomnography and Sleep Studies Jul_09 - Comment and Response (133,048 bytes)