Page 92 - Medicare Benefit Policy Manual

assistance of others) more frequently during a short period when, for example, the
presence of visiting relatives provides a unique opportunity for such absences,
than is normally the case. So long as the patient’s overall condition and
experience is such that he or she meets these qualifications, he or she should be
considered confined to the home.

• A patient who has just returned from a hospital stay involving surgery who may
be suffering from resultant weakness and pain and, therefore, his or her actions
may be restricted by the physician to certain specified and limited activities such
as getting out of bed only for a specified period of time, or walking stairs only
once a day, etc.;

• A patient with arteriosclerotic heart disease of such severity that the beneficiary
must avoid all stress and physical activity; and

• A patient with a psychiatric illness that is manifested in part by a refusal to leave
home or is of such a nature that it would not be considered safe for the patient to
leave home unattended, even if he or she had no physical limitations.

The aged person who does not often travel from home because of feebleness and
insecurity brought on by advanced age would not be considered confined to the home for
purposes of this reimbursement unless they meet one of the above conditions above.

70 - Sleep Disorder Clinics
(Rev. 1, 10-01-03)
B3-2055

Sleep disorder clinics are facilities in which certain conditions are diagnosed through the
study of sleep. Such clinics are for diagnosis, therapy, and research. Sleep disorder
clinics may provide some diagnostic or therapeutic services, which are covered under
Medicare. These clinics may be affiliated either with a hospital or a freestanding facility.
Whether a clinic is hospital-affiliated or freestanding, coverage for diagnostic services
under some circumstances is covered under provisions of the law different from those for
coverage of therapeutic services.

A. Criteria for Coverage of Diagnostic Tests

All reasonable and necessary diagnostic tests given for the medical conditions listed in
subsection B are covered when the following criteria are met:

• The clinic is either affiliated with a hospital or is under the direction and control
of physicians. Diagnostic testing routinely performed in sleep disorder clinics
may be covered even in the absence of direct supervision by a physician;