Medicare updates explanatory note for sleep study item numbers

12 November 2024 

Medicare updated the item number explanatory note for all sleep studies from 1 July 2024 to specifically reflect what the applicable documents are when the item number refers to the test being performed in “accordance with current professional guidelines”. The clarification was provided following investigation of the home sleep study item number, but the new explanatory note applies to all sleep study items – adult and paediatric. Read the member alert from 27 June

Discussions with ASA members and industry suggest that many ASA physician members may be unaware of the specifics of these documents and the importance that they are followed closely to ensure compliance with the item number for sleep studies. ASA members may inadvertently be vulnerable to non-compliance with the item numbers, even with a well-performed test, if things such as electrode placements are not exactly as written in the guideline documents.
 
With any compliance activity, Medicare makes its own interpretation of the item number description, explanatory note and guidelines, rather than what the clinician thinks may be appropriate. While groups such as the ASA may be asked for advice, Medicare may not follow our advice and comes to its own decisions based on its own guidelines and procedures. 
 
The ASA is in ongoing discussions with the Department of Health to discuss the feedback we have received from members. The Board will also propose to the Clinical Committee to review our recently-published Guidelines for sleep studies in adults to see if there can be further clarification. In addition, through the Clinical Committee, the ASA will begin the process of convening a writing group to update the Australasian Commentary on the AASM Manual for the Scoring of Sleep and Associated Events.