CMS Pub. 100-03, ch. 1, § 240.4.1

March 3, 2009)

(Rev. 103, Issued: 07-10-09, Effective: 03-03-09, Implementation: 08-10-09)

A. General

Obstructive sleep apnea (OSA) is the collapse of the oropharyngeal walls and the obstruction of airflow

occurring during sleep. Diagnostic tests for OSA have historically been classified into four types. The most

comprehensive is designated Type I attended facility based polysomnography (PSG), which is considered

the reference standard for diagnosing OSA. Attended facility based polysomnogram is a comprehensive

diagnostic sleep test including at least electroencephalography (EEG), electro-oculography (EOG),

electromyography (EMG), heart rate or electrocardiography (ECG), airflow, breathing/respiratory effort, and

arterial oxygen saturation (SaO2) furnished in a sleep laboratory facility in which a technologist supervises

the recording during sleep time and has the ability to intervene if needed. Overnight PSG is the conventional

diagnostic test for OSA. The American Thoracic Society and the American Academy of Sleep Medicine

have recommended supervised PSG in the sleep laboratory over 2 nights for the diagnosis of OSA and the

initiation of continuous positive airway pressure (CPAP).

Three categories of portable monitors (used both in attended and unattended settings) have been developed

for the diagnosis of OSA. Type II monitors have a minimum of 7 channels (e.g., EEG, EOG, EMG, ECG-heart rate, airflow, breathing/respiratory effort, SaO2)-this type of device monitors sleep staging, so AHI can

be calculated). Type III monitors have a minimum of 4 monitored channels 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 devices may measure one, two, three or more parameters but do not meet all the

criteria of a higher category device. Some monitors use an actigraphy algorithm to identify periods of sleep

and wakefulness.

B. Nationally Covered Indications

Effective for claims with dates of service on and after March 3, 2009, the Centers for Medicare & Medicaid

Services finds that the evidence is sufficient to determine that the results of the sleep tests identified below

can be used by a beneficiary’s treating physician to diagnose OSA, that the use of such sleep testing

technologies demonstrates improved health outcomes in Medicare beneficiaries who have OSA and receive

the appropriate treatment, and that these tests are thus reasonable and necessary under section 1862(a)(1)(A)

of the Social Security Act.

1. Type I PSG is covered when used to aid the diagnosis of OSA in beneficiaries who have clinical signs

and symptoms indicative of OSA if performed attended in a sleep lab facility.

2. Type II or Type III sleep testing devices are covered when used to aid the diagnosis of OSA in

beneficiaries who have clinical signs and symptoms indicative of OSA if performed unattended in or out of a

sleep lab facility or attended in a sleep lab facility.

3. Type IV sleep testing devices measuring three or more channels, one of which is airflow, are covered

when used to aid the diagnosis of OSA in beneficiaries who have signs and symptoms indicative of OSA if

performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.

4. Sleep testing devices measuring three or more channels that include actigraphy, oximetry, and peripheral

arterial tone, are covered when used to aid the diagnosis of OSA in beneficiaries who have signs and

symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep

lab facility.

C. Nationally Non-Covered Indications

Effective for claims with dates of services on and after March 3, 2009, other diagnostic sleep tests for the

diagnosis of OSA, other than those noted above for prescribing CPAP, are not sufficient for the coverage of

CPAP and are not covered.

D. Other

N/A

(This NCD last reviewed March 2009.)