The Centers for Medicare and Medicaid Services (CMS) has released the final coverage decision for sleep testing for the diagnosis of obstructive sleep apnea (OSA).

The final policy identifies the sleep tests that can be used by a beneficiary’s treating physician to diagnose OSA. Additionally, CMS finds that the use of such sleep tests demonstrates improved health outcomes in Medicare beneficiaries who have OSA and receive the appropriate treatment. Therefore, CMS finds that the following tests are reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act:

• Type I Polysomnography (PSG) is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) in beneficiaries who have clinical signs and symptoms of OSA if performed attended in a sleep lab facility
• A Type II or a Type III sleep testing device is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) in beneficiaries who have clinical signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility
• A Type IV sleep testing device measuring three or more channels, one of which is airflow, is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) in beneficiaries who have signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility
• A sleep testing device measuring three or more channels that include actigraphy, oximetry, and peripheral arterial tone is covered when used to aid the diagnosis of obstructive sleep apnea (OSA) in beneficiaries who have signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.

The complete final decision can be read online.

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