CMS Seeking Comments on Draft Policy on Home Sleep Testing

January 11, 2005
The AARC has just learned of a new draft decision on home unattended sleep testing for obstructive sleep apnea (OSA) that would continue Medicare’s current policy of not covering these unattended tests.

The decision stems from recent efforts spearheaded by Terence M. Davidson, MD, from the University of California San Diego School of Medicine, aimed at gaining Medicare coverage for home sleep testing for the diagnosis of obstructive sleep apnea. The Centers for Medicare and Medicaid Services (CMS) investigated the request and concluded that there is currently insufficient medical evidence to support Medicare reimbursement. Specifically, the draft decision states:

“The evidence is not adequate to conclude that the use of unattended portable multi-channel sleep testing with a minimum of 7 monitored channels including EEG, EOG, EMG, ECG or heart rate, airflow, respiratory effort, and oxygen saturation (Type II Devices based on the
1994 ASDA classification) is reasonable and necessary in the diagnosis of OSA and these tests will remain noncovered for this purpose.”

And—

“The evidence is not adequate to conclude that the use of unattended portable multi-channel sleep testing with a minimum of 4 monitored channels including ventilation or airflow, heart rate or ECG, and oxygen saturation (Type III Devices based on the 1994 ASDA classification system) is reasonable and necessary in the diagnosis of OSA and these tests will remain noncovered for this purpose.”

Currently, Medicare will only cover polysomnography performed in a facility-based sleep study laboratory to identify patients with OSA who require treatment with CPAP.

CMS is collecting comments on the draft decision until February 4. Comments may be made online or by contacting the following CMS staff:

Tiffany Sanders, MD
Francina C. Spencer

CMS requests commenters include “CAG-00093R” in e-mail correspondence.

You can read the entire draft decision on the CMS web site.

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