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April 2014
Find out the latest BCBSM guidelines for home, in-lab sleep testing
Home sleep testing has become an alternative to in-lab polysomnography for the diagnosis and management of moderate to severe sleep apnea.
Guidelines to use
for scoring hypopneas
We have received a number of inquiries about the scoring of hypopneas because the American Academy of Sleep Medicine and Centers for Medicare & Medicaid Services have different criteria for recording them.
The AASM criteria: Recommends scoring hypopneas in adults when there is a 3 percent or higher oxygen desaturation from pre-event baseline or the event is associated with an arousal.
The CMS criteria: Recommends scoring hypopneas in adults when there is a 4 percent or higher oxygen desaturation from pre-event baseline.
BCBSM asks that each sleep center select one of the hypopnea scoring rules and use that rule for all Blues members. The lab should reflect this in its policies and procedures and state the specific BCBSM scoring rule on the polysomnography report.
For more information on the revised hypopnea scoring rules, see the statements posted on aasmnet.org**.
Blue Cross Blue Shield of Michigan is discussing a program for the appropriate use of home and in-lab sleep testing with the help of the professional sleep community.
In the meantime, here are some guidelines for sleep testing that BCBSM aligns with:
- The American Medical Association’s sleep testing guideline revisions featured in the November 2011 edition of CPT Assistant (Pages 3-4)
- The CPT 2014 Professional Edition manual
- The Centers for Medicare & Medicaid Services coverage guidelines**
- The American Academy of Sleep Medicine’s guidelines for attended polysomnogram
In addition, BCBSM has its own policies for sleep testing:
- Polysomnography is provided in the laboratory setting and is attended by a technician, with the patient sleeping in the laboratory at the time of testing. The place of service must be designated as either an outpatient hospital facility or a doctor’s office. The CPT codes for in-lab testing are *95782, *95783, *95805, *95808, *95810 and *95811, which are listed in the CPT manual.
- Home sleep tests are unattended by a technician. The patient is sleeping at home, and the data is recorded and stored on the home sleep testing device for professional analysis at a later time. These home sleep studies are also known as remote studies, and the place of service must be designated as home. Most providers use the CPT code *95806 for this service, however BCBSM is in the process of expanding the codes used for home sleep testing, including the G codes. We will implement these codes at a later date.
- BCBSM defines the place of service as where the patient is located at the time the service is performed.
- The real-time remote recording and transmission of sleep testing data, including audio-visual patient recordings to a central monitoring station, does not meet BCBSM’s telemedicine policy.
**BCBSM does not control this website or endorse its general content. | 