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Reimbursements What's New? Archive

On December 20, 2006, President Bush signed the Tax Relief and Health Care Act of 2006, which avoids the 5% reduction to Medicare physician payments that were set to begin on January 1, 2007. See the 2007 payment rates listed under CPT Coding for Sleep Testing.

On February 1, 2006 – The Budget Reconciliation package was passed; this legislation reverses the 4.4% reduction in Medicare physician payments that became effective January 1, 2006.

The physician fee schedule payments will remain at 2005 rates, as reflected in the payment rates listed under CPT Coding for Sleep Testing.

December 2005 – Since Congress was unable to come to agreement on budget reconciliation legislation prior to the winter holidays, the Centers for Medicare and Medicaid services (CMS) was obligated to impose a scheduled average 4.4% reduction in Medicare physician payments, effective January 1, 2006.

Both the House and the Senate had passed legislation to remove the cuts and maintain physician fee schedule payments at 2005 rates, but differences on other language prevented the bill from being signed into law.

A February 1, 2006 House vote is expected.  The fee schedule amounts for sleep diagnostic procedures on www.sandmansleep.com will be updated immediately following passage or rejection of the budget reconciliation legislation.

November 22, 2005 – The Centers for Medicare and Medicaid Services (CMS) published new and revised ICD-9-CM Diagnosis codes on the Medicare Learning Network ( www.cms.hhs.gov/medlearn/icd9code.asp - Tables 6A and 6E). Below are examples of several codes specific to sleep disordered breathing. These new and revised codes are effective October 1, 2005 :

The Centers for Medicare and Medicaid Services (CMS) has released the 2006 Medicare Fee Schedule Final Rule.  Though the final rule reduces physician payment by a projected 4.4 per cent, Congressional intervention could eliminate these cuts in the 2006 budget reconciliation bill.   www.sandmansleep.com will be updated with the final 2006 physician fee schedule allowables as soon as they are released.

April 4, 2005 : The Centers for Medicare and Medicaid Services (CMS) issued a national coverage determination (NCD) stating that Medicare will not cover certain unattended tests performed to diagnose obstructive sleep apnea (for subsequent treatment with CPAP) http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=110 . The key points of this NCD are as follows:

• The evidence to date 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.
• The evidence to date 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.

In order for Medicare to cover continuous positive airway pressure (CPAP) under the current NCD, Publication 100-03, Medicare National Coverage Determinations Manual, section 240.4, an individual must have obstructive sleep apnea (OSA) as demonstrated by polysomnography done in a facility-based sleep study laboratory.