Notice: This CMS-approved document has been submitted - Philips ...

CMS-1403-FC
by the Medicare program. We believe that in most cases the
provider that would be submitting a claim for payment
related to the sleep test will not be the beneficiary’s
primary physician but will be another party, for example,
another physician or a diagnostic testing entity. We note
that only rarely would a Medicare participating physician
also be enrolled as a Medicare DME supplier.
b. Regulation
In the CY 2009 PFS proposed rule, we proposed to
prohibit DME supplier payment for a CPAP device if the
provider of a sleep test that is used to diagnose
obstructive sleep apnea (OSA) in the Medicare beneficiary
is the DME supplier or an affiliate of the supplier of the
CPAP machine used to treat the beneficiary’s sleep apnea.
The proposal applied to all sleep testing from attended
facility-based PSG to unattended HST.
Based on section 1871(a)(1) of the Act, which provides
the Secretary with the authority to “prescribe such
regulations as may be necessary to carry out the
administration of the insurance programs under this title,”
and section 1834(j)(1)(B)(ii)(IV), which requires suppliers
of equipment and supplies to “meet such other requirements
as the Secretary may specify,” and due to our concerns with
respect to the potential for unnecessary utilization of
729