Accreditation and Credentialing Requirements for Polysomnography LCD L36593

**Revision effective date:   **

For services performed on or after **07/01/2018**



**Accreditation and credentialing requirements:**

****Please be aware of the following changes to accreditation and
credentialing requirements:****

Palmetto GBA Local Coverage Determination L36593 sets forth the following
standards for sleep centers that perform the technical component (TC) of
polysomnography (PSG) and sleep testing (including home sleep testing):

**1.** **The sleep center or laboratory must maintain documentation on file
that indicates it is accredited by either: ** ****

  * **the American Academy of Sleep Medicine (AASM), or**

  * **the  Accreditation Commission for Health Care (ACHC), or **

  * **the Ambulatory Care Accreditation Program of the Joint Commission** ** _ _**

This documentation must be available on request. The AASM, ACHC, or Joint
Commission accreditation applies to the hospital and freestanding facilities
(including sleep clinics that are part of a physician's office, and all other
non-hospital-based facilities where sleep studies are performed. **Diagnostic
testing performed in an Independent Diagnostic Testing Facility (IDTF) must
follow the supervision and credentialing guidelines set forth by CMS and/or
Palmetto GBA.** _  
  
_The sleep laboratory or testing facility must be affiliated with a hospital
or be under the direction and control of a physician (MD/DO) who meets 1 of
the following requirements, even though the diagnostic test may be performed
in the absence of direct physician supervision. **The raw data from all sleep
tests must be reviewed and the tests must be interpreted by a physician who
meets at least 1 of the following requirements:**  

    * Certification in Sleep Medicine by the American Board of Sleep Medicine (ABSM) or by a member board of either the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)  

    * A completed fellowship in sleep medicine through an Accreditation Council for Graduate Medical Education (ACGME)-accredited program. Following the completed fellowship, certification in sleep medicine is completed within 2 examination cycles through the American Board of Sleep Medicine (ABSM) or a member board of either the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)

Sleep centers in Jurisdiction M have been subject to these regulations since
the implementation of the LCD on October 1, 2015 and similar regulations that
appeared in previous versions of the Polysomnography LCD.



Sleep centers in Jurisdiction J prior to February 26, 2018 were not required
to meet similar standards by the previous contractor. All sleep centers in
Jurisdiction J must now obtain accreditation by 1 of the 3 organizations
listed above by July 1, 2018 in order to continue to render services to
Medicare beneficiaries and submit claims to Palmetto GBA.



**Revision effective date:   **

For services performed on or after **10/01/2018**



**2\. As noted above in section 1, and as of October 1, 2018, outpatient sleep
centers affiliated with a hospital, which is currently accredited by the Joint
Commission (formerly JCAHO) through the hospital 's accreditation are required
to have ambulatory care accreditation for the sleep center in order to
continue to render services to Medicare beneficiaries and submit claims to
Palmetto GBA.**

****3\. There is a new physician-credentialing standard published by the Joint
Commission (formerly JCAHO) for ambulatory care organizations providing sleep
center services that reduces quality variation and aligns credentialing
requirements for all sleep testing facilities defined by the Polysomnography
LCD. Specifically, as of January 1, 2018, the Joint Commission requires that
organizations verify that physicians have _at least 1_ of the following
qualifications before granting initial or revised privileges to physicians
responsible for interpreting sleep studies:****  

    * Certification in Sleep Medicine by the American Board of Sleep Medicine (ABSM) or by a member board of either the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)

**OR**

    * A completed fellowship in sleep medicine through an Accreditation Council for Graduate Medical Education (ACGME)-accredited program. Following the

completed fellowship, certification in sleep medicine is completed within 2
examination cycles through the American Board of Sleep Medicine (ABSM) or a
member board of either the American Board of Medical Specialties (ABMS) or the
American Osteopathic Association (AOA).

The above language is not a new requirement under the Polysomnography LCD
L36593. Since its implementation on October 1, 2015, this LCD has required and
continues to require, regardless of the standards put forth by any of the 3
listed accrediting organizations, that the sleep laboratory or testing
facility be affiliated with a hospital or be under the direction and control
of a physician (MD/DO) who meets 1 of the above requirements. The raw data
from all sleep tests must be reviewed and the tests must be interpreted by a
physician who meets at least 1 of the above requirements. This documentation
must be available upon request. Please review the entire LCD (L36593) for
complete information regarding polysomnography testing and billing
requirements.