Medicare Compliance & Reimbursement

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, Type III, or Type IV monitoring devices.

Sleep testing monitoring devices are classified into the following types:

• Type I monitoring: Full inlaboratory polysomnography.

• Type II monitoring: Comprehensive portable polysomnography with a minimum of seven channels including EEG, EOG, chin EMG, ECG or heart rate, airflow, respiratory effort, and oxygen saturation.

• Type III monitoring: Modified portable sleep apnea monitoring with a minimum of four channels monitored including ventilation or airflow (at least two channels of respiratory movement, or respiratory movement and airflow), heart rate or ECG, and oxygen saturation.

• Type IV monitoring: Monitoring with continuous single or dual parameters, one or two channels, typically including oxygen saturation or airflow.

Hence, Medicare created HCPCS G codes to address a very limited NCD for home sleep study testing (HST). Check the number of different parameters monitored, i.e. the type of monitoring performed, to choose from these codes:

• G0398 -- Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation.

• G0399 -- ... with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation.

• G0400 -- ... with type IV portable monitor, unattended; minimum of 3 channels. Also note that Medicare redefined the traditional Type IV monitoring classification to require measurement of at least three channels.

Many payers won't cover home sleep study testing for patients with comorbidities such as congestive heart failure, insomnia, narcolepsy, or other conditions, so check your payer's policy.