The Centers for Medicare & Medicaid Services has released a new policy for Medicare coverage of testing for the diagnosis of obstructive sleep apnea (OSA).
The decision provides coverage for specified sleep tests that are used to confirm the diagnosis in patients who have clinical signs and symptoms of OSA.
“Medicare beneficiaries who have obstructive sleep apnea face significant risks for cardiovascular disease and other ailments,” said CMS Acting Administrator Charlene Frizzera. “This coverage decision establishes nationally consistent coverage and assures that beneficiaries who have sleep apnea can be appropriately diagnosed and referred for treatment.”
OSA is characterized by periods of apnea during sleep. Apnea is defined as a temporary absence in breathing. Persons with OSA usually snore (though not everyone who snores has OSA) and tend to exhibit daytime drowsiness that can cause accidents with motor vehicles and machinery. Long-term OSA can lead to cardiovascular problems.
A doctor may suspect OSA from taking a patient’s medical history and performing a physical examination. The diagnosis can be confirmed with a sleep test, during which the patient’s breathing, heart rate and other factors are recorded and interpreted.
With this decision, CMS will have nationally consistent coverage for sleep testing for the diagnosis of OSA. This includes coverage of more complex tests that are usually furnished in a sleep laboratory facility as well as many types of home sleep testing. These tests have previously been covered by local Medicare contractor policies, which in some cases varied from state to state.
Photo obtained under Creative Commons license. -Ed