LCD ID Number: L36593 Status: A-Approved
LCD Title: Polysomnography
Geographic Jurisdiction: North Carolina Other Jurisdictions
Original Determination Effective Date:
06/13/2016
Original Determination Ending Date:
Revision Effective Date:
03/16/2023
Revision End Date:
CMS National Coverage Policy:
Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or to improve the functioning of a malformed body member.
Title XVIII of the Social Security Act, §1862(a)(1)(D) Items and services related to research and experimentation
42 CFR §410.32(a) indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements).
CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §70 Sleep Disorder Clinics
CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 1, §30.4 Electrosleep Therapy
CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, §240.4 Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA) (Effective March 13, 2008) and §240.4.1 Sleep Testing for Obstructive Sleep Apnea (OSA) (Effective March 3, 2009)
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