tci Medicare Compliance & Reimbursement - 2010 Issue 1

READER QUESTION: Nail Down Sleep Study Type To Determine Coverage

Medicare has strict requirements about tests performed in the patient's home. Question: Our practice is considering providing home sleeps studies. Does Medicare cover sleep studies when performed in the patient's home?Answer: As is often the case, the answer is, "it depends." In March 2008, Medicare expanded its National Coverage Determination (NCD) for sleep studies to include restricted coverage of home sleep tests, only to detect Obstructive Sleep Apnea (OSA). The NCD confirmed coverage not only for in-lab attended polysomnography, but also for unattended sleep testing performed in or out of a sleep facility using any Type II...

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