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Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor Contractor Number: 10111 Contractor Type: MAC A

LCD Information

LCD ID Number: L38276 Status: A-Approved LCD Title: Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea Geographic Jurisdiction: Alabama Other Jurisdictions Original Determination Effective Date: 06/21/2020 Original Determination Ending Date: Revision Effective Date: 04/13/2023 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 injury 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. Title XVIII of the Social Security Act, §1862 (a)(7) states Medicare will not cover any services or procedures associated with routine physical checkups. CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §60.1 Incident To Physician’s Professional Services and §110 Durable Medical Equipment – General CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 2, §160.7 Electrical Nerve Stimulators 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) and §240.4.1 Sleep Testing for Obstructive Sleep Apnea (OSA) Sorry, you need to login or register to view additional sections of this Medicare policy. *