Some Home Sleep Testing LCDs Roll Out, But Providers Still Have a Voice

April 17, 2008

Already, two local coverage determinations (LCDs) regarding home sleep testing have been released, though the LCDs that will impact respiratory providers aren’t expected until May or June, according to industry sources.

Tom Pontzius, president of VGM’s Nationwide Respiratory, says he take away from these LCDs is that some of the rules from the national coverage determination (NCD) are being incorporated.

Providers should see at least eight more of LCDs related to the "testing" (or diagnostic) component, says Kelly Riley, director of The MED Group’s National Respiratory Network. She expects further LCDs on the treatment component. The testing LCDs are expected to clarify who is qualified to do the test, HCPCS codes, reimbursement for testing and medical necessity requirements, Riley says.

To view the LCD from Empire, visit www.empiremedicare.com/nyorkpolicya/policy/l26428_final_lcd_ngs.htm. To view the LCD from Highmark Medicare Services, visit www.highmarkmedicareservices.com/policy/mac-ab/j12-d44.html.

“The regional medical directors are receiving correspondence from varying industry types: physicians, home care providers and sleep labs,” Pontzius says. “I strongly suggest that people write to their local medical directors and provide their opinions. There is still time to affect the policy that is forthcoming.”

To contact your state medical director, check the list below, provided by Nationwide Respiratory.

Regional Medical Directors by State
Alaska:
Dr. Richard Whitten, Noridian Administrative Services
(808) 522-1570
Dick.Whitten@noridian.com

Alabama:
Dr. James E. Strong, Cahaba Government Benefits Administration
(205) 220-1216
jstrong@cahabagba.com

Arkansas:
Dr. Sidney Hayes, Pinnacle
(501) 210-6524
sphayes@PinnacleBSI.com

Arizona:
Dr. William Mangold, JD, Noridian Administrative Services
(602) 749-2506
William.Mangold@noridian.com

California:
Dr. Elaine Jeeter, Palmetto
(803) 735.1034, Ext. 35059

Colorado:
Dr. Deborah Patterson, Trailblazer Health Care Services
(469) 372-1262 or (469) 372-6074
deborah.patterson@trailblazerhealth.com

Connecticut:
Dr. Paul Deutsch, National Government Services
(317) 841-4607

Delaware:
Dr. Andrew Bloschicak, MBA, Highmark
(717) 302-4199
Andrew.bloschichak@hgsa.com

District of Columbia:
Dr. Andrew Bloschicak, MBA, Highmark
(717) 302-4199
Andrew.bloschichak@hgsa.com

Florida:
Dr. James Corcoran, First Coast Service Options
(904) 791-6111 (switchboard)
James.corcoran@fcso.com

Georgia:
Dr. James E. Strong, Cahaba Government Benefits Administration
(205) 220-1216
jstrong@cahabagba.com

Hawaii:
Dr. Elaine Jeeter, Palmetto
(803) 735.1034, Ext. 35059

Iowa:
Dr. Kenneth Bussan, Wisconsin Physicians Service
(608) 301-2604
kbussan@wpsic.com

Idaho:
Dr. Boyd K. Honeycutt, MBA, FACP, CIGNA Government Services
(336) 821-4511
Boyd.honeycutt@cigna.com

Illinois:
Dr. David Luce, Wisconsin Physicians Service Insurance Corporation
(608) 221-4711 (switchboard)
david.luce@wpsic.com

Indiana:
Dr. Carolyn Cunningham, National Government Services
(317) 841-4607
Carolyn.Cunningham@anthem.com

Kansas:
Dr. Kenneth Bussan, Wisconsin Physicians Service
(608) 301-2604
kbussan@wpsic.com

Kentucky:
Dr. Carolyn Cunningham, National Government Services
(317) 841-4607
Carolyn.Cunningham@anthem.com

Louisiana:
Dr. Lynn Hickman, Pinnacle
(866) 280-6520
sphayes@pinnaclebsi.com

Massachusetts:
Dr. Craig Haugh, National Heritage Insurance Co.
(972) 624-600 or (781) 741-3122
Craig.haug@eds.com

Maryland:
Dr. Andrew Bloschicak, MBA, Highmark
(717) 302-4199
Andrew.bloschichak@hgsa.com

Maine:
Dr. Craig Haugh, National Heritage Insurance Co.
(972) 624-600 or (781) 741-3122
Craig.haug@eds.com

Michigan:
Dr. David Luce, Wisconsin Physicians Service Insurance Corporation
(608) 221-4711 (switchboard)
david.luce@wpsic.com

Minnesota:
Dr. David Luce, Wisconsin Physicians Service Insurance Corporation
(608) 221-4711 (switchboard)
david.luce@wpsic.com

Missouri:
Dr. Kenneth Bussan, Wisconsin Physicians Service
(608) 301-2604
kbussan@wpsic.com

Mississippi:
Dr. James E. Strong, Cahaba Government Benefits Administration
(205) 220-1216
jstrong@cahabagba.com

Montana:
Dr. William Mangold, JD, Noridian Administrative Services
(602) 749-2506
William.Mangold@noridian.com

North Carolina:
Dr. Boyd K. Honeycutt, MBA, FACP, CIGNA Government Services
(336) 821-4511
Boyd.honeycutt@cigna.com

North Dakota:
Dr. George Waldmann, Noridian Administrative Services
(503) 944-8810
George.Waldmann@noridian.com

Nebraska:
Dr. Kenneth Bussan, Wisconsin Physicians Service
(608) 301-2604
kbussan@wpsic.com

New Hampshire:
Dr. Craig Haugh, National Heritage Insurance Co.
(972) 624-600 or (781) 741-3122
Craig.haug@eds.com

New Jersey:
Dr. Andrew Bloschicak, MBA, Highmark
(717) 302-4199
Andrew.bloschichak@hgsa.com

New Mexico:
Dr. Deborah Patterson, Trailblazer Health Care Services
(469) 372-1262 or (469) 372-6074
deborah.patterson@trailblazerhealth.com

Nevada:
Dr. Elaine Jeeter, Palmetto
(803) 735.1034, Ext. 35059

New York:
Dr. Paul Deutsch, National Government Services
Upstate & Downstate New York
2651 Strang Blvd./Yorktown Heights, NY 10598

Dr. Joseph Presto, Group Health
Queens
(646) 458-6600, Ext. 6671
presto@guimedicare.com

Ohio:
Dr. Harry Feliciano, Palmetto
(803) 763-5007
Harry.feliciano@palmettogba.com

Oklahoma:
Dr. Deborah Patterson, Trailblazer Health Care Services
(469) 372-1262 or (469) 372-6074
deborah.patterson@trailblazerhealth.com

Oregon:
Dr. George Waldmann, Noridian Administrative Services
(503) 944-8810
George.Waldmann@noridian.com

Pennsylvania:
Dr. Andrew Bloschicak, MBA, Highmark
(717) 302-4199
Andrew.bloschichak@hgsa.com

Rhode Island:
Dr. Mayo Gilson, Pinnacle Medicare Services
(866) 280-6520
sphayes@pinnaclebsi.com

South Carolina:
Dr. Harry Feliciano, Palmetto
(803) 763-5007
Harry.feliciano@palmettogba.com

South Dakota:
Dr. George Waldmann, Noridian Administrative Services
(503) 944-8810
George.Waldmann@noridian.com

Tennessee:
Dr. Boyd K. Honeycutt, MBA, FACP, CIGNA Government Services
(336) 821-4511
Boyd.honeycutt@cigna.com

Texas:
Dr. Deborah Patterson, Trailblazer Health Care Services
(469) 372-1262 or (469) 372-6074
deborah.patterson@trailblazerhealth.com

Utah:
Dr. William Mangold, JD, Noridian Administrative Services
(602) 749-2506
William.Mangold@noridian.com

Virginia:
Dr. Deborah Patterson, Trailblazer Health Care Services
(469) 372-1262 or (469) 372-6074
deborah.patterson@trailblazerhealth.com

Vermont:
Dr. Craig Haugh, National Heritage Insurance Co.
(972) 624-600
Craig.haug@eds.com

Washington:
Dr. Richard Whitten, Noridian Administrative Services
(808) 522-1570
Dick.Whitten@noridian.com

Wisconsin:
Dr. David Luce, Wisconsin Physicians Service Insurance Corporation
(608) 221-4711 (switchboard)
david.luce@wpsic.com

West Virginia:
Dr. Harry Feliciano, Palmetto
(803) 763-5007
Harry.feliciano@palmettogba.com

Wyoming:
Dr. Robert Szczys, Noridian Administrative Services
(303) 858-5641
Robert.Szczys@noridian.com