Sleep Studies

This payment policy describes reimbursement guidelines applicable to Sleep Studies including polysomnography. The policy applies to professional services reported on a CMS1500 claim form (or its electronic equivalent). Obstructive Sleep Apnea (OSA) is one of the most common sleep-related breathing disorders in the United States and is associated with significant morbidity and healthcare utilization. It is estimated that approximately 25 million adults in the United States have OSA, with many cases remaining undiagnosed. Prevalence increases with age, obesity, male sex, and the presence of cardiovascular and metabolic conditions. OSA has been associated with hypertension, coronary artery disease, stroke, heart failure, atrial fibrillation, diabetes mellitus, excessive daytime sleepiness, impaired quality of life, and increased risk of motor vehicle accidents and occupational injuries. Obstructive sleep apnea (OSA) syndrome is characterized by repetitive episodes of upper airway obstruction due to the collapse of the upper airway during sleep. Polysomnography and portable sleep apnea testing (with sensors for respiratory effort, airflow, and oxygen saturation, or alternatively with peripheral arterial tone [PAT], actigraphy, and oxygen saturation) are established methods for diagnosing OSA. Other proposed methods of diagnosing OSA include limited channel home sleep monitors. Central Sleep Apnea (CSA) is a less common form of sleep apnea but can be associated with similar diagnoses resulting in increased morbidity and mortality. There are other sleep related disorders that are present within the medical community, and similar to CSA are most commonly tested using facility-based polysomnography for accurate diagnosis. Due to the high prevalence and associated health risks, appropriate identification and diagnosis through medically necessary sleep studies are essential to guide timely and effective treatment interventions. <a id="