Friday, April 04, 2008

Home Testing not covered in many states

The AASM just linked to a new Local Coverage Determination for the following states:
Illinois, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska and Wisconsin.

Here is the link

http://www.aasmnet.org/Resources/PDF/WPSIC.pdf


Based on a quick read of the LCD, it appears that home testing will not be covered in the above states.

8 comments:

KySleep said...

I seen this, I also seen the one written by Horizon, but I am a bit confused since the date written seems to be earlier than the CMS decision on 3-8-08.

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landon said...

These CMS LCD's were drafted before the Decision memo was published on March 13. They are valid until the official NCD is published and the new LCD's are written. An LCD CAN NOT override an NCD. They may place restrictions on areas that the NCD did not address however. The Highmark region has posted a draft of their LCD for poly...

Sleep Review Article

KySleep said...

My interpretation exactly, those LCD are rendered invalid by the CMS decision in March 2008, although they may not be invalid immediately, they will become so. As I have read the Highmark draft I still only see that it specifically deals with coverage of CPAP when diagnosed with an HST, Nowhere have I read any decision that would alter the facts as of today and that is HST reimbursement is too low to send a 3 or 4 thousand dollar piece of equipment home with persons who will destroy the device in some fashion. I will not be doing HST's and if it becomes a mandate then I will not be practicing sleep!

landon said...

I found some very interesting new items today...
HCPCS Code update from medicare

Medicare has released new temporary HCPCS codes addressing billing for the different types of devices. Each Type has a seperate code, which indicates reimbursements WILL change and that there will be a reimbursement for Type IV (that will likely be less than Type II and III).

The interesting question is.. Will this invalidate the language within the Sleep Testing LCD released already that discusses that 95806 is the HCPCS code to bill for Home sleep testing?

Michael Rack, MD said...

landon,

thanks for the info on the new billing codes

sleepyceleste said...

I have no first hand knowledge, but have heard that an LCD can be more restrictive, but not more liberal than the NCD. If this true then it is possible to have some states not covering HST. Anyone know for sure about this?

landon said...

The LCD can add more restriction, but can not override, or step on an NCD. For example, the LCD could not state that Type IV devices are not allowed in this region. However, for example, they could add a restriction that only a lab with Accredited Sleep physician could bill for the test.