New Sleep Study Requirements from Medicare

Jurisdiction 11 Part B

Polysomnography Policy for J11

Effective October 1, 2011, Palmetto GBA will apply the certification requirements stated in LCD# 31718 Polysomnography to all freestanding facilities that operate and submit claims as Sleep Disorder Centers or as Laboratory for Sleep Related Breathing Disorders. Freestanding facilities include physician’s offices, Independent Diagnostic Testing Facilities (IDTF) and all other non-hospital based facilities where sleep studies are performed. If you currently submit claims for sleep study services CPT codes 95805, 95807, 95808, 95810, and 95811, you may continue to provide these services. However, you must initiate the process to obtain the required facility certification and submit this documentation to Palmetto GBA.
Please review the following information to determine the appropriate action for your facility:

• New Providers: If you are a new provider and plan to enroll and bill Medicare for sleep study services, you must obtain the required facility certification prior to performing and billing a sleep study service
• New Location: If you are currently submitting sleep study services from another location and plan to open a new location, you must initiate the process to obtain the required facility certification for the new location by January 1, 2012
• Current Provider: If you currently submit claims for sleep study services, you must initiate the process to obtain the required facility certification and submit it to Palmetto GBA by January 1, 2012
• Current Provider providing first time sleep service: If you are currently submitting other services for Medicare beneficiaries and plan to provide sleep services in the future, you must obtain the required facility certification prior to performing and billing a sleep study service

Please fax or mail your certification/documentation to the following number/address:
FAX: ATTN: Sleep Accreditation Verification to (803) 699-2438

Address:
Palmetto GBA
Polysomnography Certification – AG-310
P.O. Box 100190
Columbia SC 29202-3190
Effective January 1, 2012, Palmetto GBA will deny services submitted by freestanding facilities that do not meet the policy certification requirements.
Accepted certification requirements:

• The American Academy of Sleep Medicine (AASM) accreditation certificate
• AASM provisional documentation
• AASM application acceptance documentation
• Accreditation Commission for Health Care, Inc (ACHC) accreditation certificate
• ACHC application acceptance documentation