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

CMS-1403-FC
pressure (CPAP)” and “sleep test” and to add a new
paragraph (f), which would establish a specific payment
prohibition that would not allow the supplier to receive
Medicare payment for a CPAP device if that supplier, or its
affiliate as defined above, is directly or indirectly
related to the provider of the sleep test that would used
to diagnose the beneficiary with OSA.
In this final rule, in response to public comment, we
are adding additional definitions for “affiliate”, and
“attended facility-based polysomnogram”, and clarify the
definitions of “Continuous positive airway pressure
(CPAP)”, and “sleep test.” In addition, we are adding a new
paragraph (g), which would create an exception to the
prohibition contained in (f) if the sleep test is an
attended facility-based PSG.
The following is a summary of the comments we received
and our responses.
Comment: Many commenters maintained that the
prohibition is unfair and that it “singles out” sleep
diagnostics and therapies for a special payment
prohibition. They maintain that there is no evidence that
sleep tests promote “self interested” referrals any more
than do referrals from any other diagnostic tests.
731