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August 5, 2021

Sleep Test Requirements

The Durable Medical Equipment (DME) Medicare Administrative Contractors (MACs) published a revised Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L33718) Local Coverage Determination (LCD) for notice, effective for dates of service on or after August 8, 2021. This revision followed an analysis of the language in NCD 240.4.1 and the A/B MAC policies (LCDs and Billing and Coding articles). After that analysis, the DME MACs determined that the home sleep test information in the Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea LCD (L33718) was duplicative. Coverage of positive airway pressure devices will continue to rely on a Medicare-covered diagnostic sleep test with qualifying values that is eligible for coverage and reimbursement by the A/B MAC contractor.

Interested stakeholders who wish to review the applicable sleep testing A/B MAC contractor Coding and Billing Articles and LCDs may search using the term “Polysomnography” in the Medicare Coverage DatabaseExternal Website on the CMS web site.

Publication History

August 05, 2021 Originally Published

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