Medicare officials have validated the use of certain home-based tests to diagnose obstructive sleep apnea.
The Centers for Medicare and Medicaid Services had previously established a national policy of covering continuous positive airway pressure treatment for beneficiaries with obstructive sleep apnea (OSA) if they are diagnosed using certain home sleep tests. But coverage for the tests themselves had been left to the discretion of the local contractor.
In the current decision memo, CMS officials noted that the evidence is “sufficient” to find that in appropriately selected patients, certain home testing monitors can identify a significant proportion of OSA patients who are likely to respond to treatment.
Under the final coverage decision, officials at the CMS opted to cover four categories of sleep testing devices when they are used to establish a diagnosis of OSA in a symptomatic patient.
Type I tests must be performed in a sleep lab facility with an attendant. The other tests can be done either in or out of a sleep lab facility.
The nationally covered tests include:
▸ Type I polysomnography.
▸ Type II or type III sleep testing devices.
▸ Type IV sleep testing devices measuring three or more channels, one of which is airflow.
▸ Sleep testing devices measuring three or more channels that include actigraphy, oximetry, and peripheral arterial tone.
“Medicare beneficiaries who have obstructive sleep apnea face significant risks for cardiovascular disease and other ailments,” said Charlene Frizzera, CMS acting administrator. “This coverage decision establishes nationally consistent coverage and assures that beneficiaries who have sleep apnea can be appropriately diagnosed and referred for treatment.”
Obstructive sleep apnea is a commonly underdiagnosed condition that occurs in about 4% of men and 2% of women. But the prevalence increases with age, rising to 10% among Medicare-age individuals, according to the CMS.
The CMS decision to cover home sleep testing devices is likely to improve access to testing over the next 3–5 years, said Phillip Porte, executive director of the Sleep Manufacturers Alliance. But more time will be needed for the public and physicians to grow more comfortable with at-home sleep testing, he said. Patient acceptance of the technology will depend in large part on what they hear from a trusted physician, he said.
The coverage decision is good news for the millions of Americans with undiagnosed and untreated sleep apnea, said Edward Grandi, executive director of the American Sleep Apnea Association. The coverage of home sleep testing devices will give more options to patients who have not been able to get into a sleep lab, are not comfortable in a laboratory setting, or cannot afford the cost of an evaluation in a sleep lab, he said.
The memo is available at www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=227