The details will come at a later date but Medicare has approved in-home sleep testing using Type II, Type III and Type IV devises. Prior to this ruling, Medicare would pay for treatment of sleep disorders only if diagnosed in a sleep lab. Unfortunately, sleep labs could not be constructed and staffed with qualified therapists fast enough to meet demand. To the frustration of physicians, the sleep labs that do exist are often booked months in advance. Allowing diagnosis with an in-home sleep test will get treatment to those who need it more efficiently.
The details are sketchy at best. We know the three types of devises approved, with a Type IV being the most simple devise. The test must measure at least three channels of information but we do not know what the three channels must be. A local coverage determination will be done in the future that will spell out the details, including who can perform the tests, what reimbursement rates are and the minimum channels to be measured.
Diagnosis with an in-home study will only qualify treatment payment for 3 months. After 3 months, treatment must be documented effective to continue reimbursement. The requirements of effective treatment along with the documentation needed are also unknown at this time.
The CMS final rule comes as know surprise to me. I was expecting this ruling. The in-home tests are cost effective and accurate when performed by competent personnel. I am surprised CMS allowed Type IV devises in their final rule, though. I was expecting Type II and Type III devises to be included but Type IV devises to be excluded.
Overall, I believe this is a good ruling for the consumer. The wait time for testing will be significantly reduced along with the cost of diagnosis. Compliance and followup will be assured due to the documentation required at 3 months of treatment. I hope that CMS requires testing entities be accredited by the American Academy of Sleep Medicine. CMS could further require tests to be read by qualified sleep physicians. What CMS does now will eventually decide the long-term success of in-home sleep diagnostics but their first step was a good one.
Respiratory Report 