The Centers for Medicare & Medicaid Services (CMS) announced today a new policy for Medicare coverage of sleep testing for the diagnosis of obstructive sleep apnea (OSA).

The decision provides coverage for specified sleep tests that are used to confirm the diagnosis in patients who have clinical signs and symptoms of OSA.

OSA is a condition that is characterized by periods of apnea during sleep. Apnea is defined as a temporary absence in breathing.  Persons with OSA usually snore; however, not everyone who snores has OSA.  Persons with OSA also tend to exhibit daytime drowsiness that can cause accidents with motor vehicles and machinery.   Long term OSA can lead to cardiovascular problems.

A doctor may suspect OSA from taking a patient’s medical history and performing a physical examination.  The diagnosis may be confirmed with a sleep test, during which the patient’s breathing, heart rate and other factors are recorded and interpreted.  In general, OSA is diagnosed by counting the number of apnea episodes or breathing disturbances that occur during a specific time span.

“Medicare beneficiaries who have obstructive sleep apnea face significant risks for cardiovascular disease and other ailments,” said CMS Acting Administrator Charlene Frizzera. “This coverage decision establishes nationally consistent coverage and assures that beneficiaries who have sleep apnea can be appropriately diagnosed and referred for treatment.”

With this decision, CMS will have nationally consistent coverage for sleep testing for the diagnosis of OSA.  This includes coverage of more complex tests that are usually furnished in a sleep laboratory facility as well as many types of home sleep testing.  These tests have previously been covered by local Medicare contractor policies which in some cases varied from state to state. 

This decision does not apply to the use of these tests for other purposes beyond the diagnosis of OSA.  Local Medicare contractors may continue to determine coverage on other uses within their own jurisdictions.

Today’s decision memorandum is available on CMS’ Coverage Web site at https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=227