DME MAC contractors for the Centers for Medicare and Medicaid Services revised their local coverage determinations (LCDs) for positive airway pressure (PAP) devices.
“The revision addresses physician credentialing and the interpretation of facility-based polysomnograms (PSG),” stated NHIC in an e-mail to members. “The current policy requirement is based on the date of service the PAP device is dispensed. The revised policy requirement is based on the date of service of the facility-based polysomnogram.”
The revisions are effective for dates of service (DOS) on or after January 1, 2010.
The consequences of this change are illustrated in the scenarios below:
Polysomnogram date: November 15, 2009, by a noncredentialed physician
PAP device initial DOS: January 15, 2010
The current policy requires that for PAP devices with DOS on or after January 1, 2010, the interpreting physician must meet credentialing requirements. In the scenario presented, the PAP device would be denied since DOS for PAP claim is after January 1, 2010.
The revised policy requires that physicians interpreting facility-based PSGs performed on or after January 1, 2010, must be credentialed. In the scenario presented, the PAP device would be allowed since date of test is prior to effective date of January 1, 2010, for credentialing requirement.
Suppliers are encouraged to read LCDs and policy articles for additional coverage, coding and documentation guidance.
