Effective for dates of service on or after March 13, 2008, Medicare will allow for coverage of CPAP therapy based upon a diagnosis of OSA by home sleep testing.
Performance of home sleep testing is limited to FDA approved devices furnished with adequate patient instruction and support to assure successful completion and reliable results. Provision of the device, patient instruction and support can be provided by sleep centers, physicians, and Independent Diagnostic Testing Facilities who can demonstrate use of FDA approved devices, inspection of the devices, and the patient education and support necessary.
The professional services related to home sleep testing (G0398, G0399, and G0400) are covered for the purpose of testing a patient for the diagnosis of obstructive sleep apnea if the home sleep testing is reasonable and necessary for the diagnosis of the patient’s condition, meets all Medicare requirements, and the physician who performs the service has sufficient training and experience to reliably perform the service.
Home Sleep Testing is not reasonable and therefore not covered for patients with comorbidities (moderate to severe pulmonary disease, neuromuscular disease, or congestive heart failure), other sleep disorders (central sleep apnea, periodic limb movement disorder, insomnia, parasomnias, circadian rhythm disorders or narcolepsy), or for screening asymptomatic patients.
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