Initial Start to Investigate a Sleep Disorder

These are the steps in the order they should be completed:

  1. Face-to-Face Visit with your Provider or Sleep Specialist.

    • This visit has to be face-to-face. It cannot be done over the phone. The visit has to have everything listed in the Face-to-Face Checklist for Sleep Study Approval in the provider’s report at the time of the visit. CMS will not accept addendums.
  2. Sleep Study within six months of the Face-to-Face Visit.

    • If you wait too long before scheduling the test (we generally have a two to three month wait for testing), you stand a chance to have to repeat the face-to-face visit.
    • ** If you are within five years of receiving Medicare benefits please advocate “to be scored by Medicare Standards” **

  3. Treatment Ordered within six months of the testing.

  4. Face-to-Face Visit with your provider to download the machine and discuss the treatment within 31-90 days of receiving the machine (i.e. if you come in for this visit too early or too late CMS will not accept the information).

    • The download of the machine must show compliance of use. CMS states that compliance is ≥ 4 hours per night 70% of the time within a 30-day period.
      • Should you not show compliance, the treatment device will be taken back by the Equipment Company and the entire process will have to be repeated.
      • Once again all the information on this checklist should be in the provider’s report. An addendum or telephone conversation will not be permitted.

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