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Sleep Disorder Testing - PDF by tyndale

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									                                        Sleep Disorder Testing

Please refer to Medical Policy #305 Polysomnography/Sleep Disorders Testing on the Blue Cross and
Blue Shield of Alabama’s web site at

https://www.bcbsal.org/providers/policies/final/305.pdf.

To be considered for coverage in the Preferred Medical Doctor (PMD) service area, Polysomnography or
sleep disorder testing must be performed in a Plan approved accredited sleep center or laboratory, and
must be interpreted by a PMD board certified or board eligible sleep disorders specialist. The center or
laboratory must be accredited by the American Academy of Sleep Medicine (AASM) or The
Accreditation Commission for Health Care Sleep Labs Program (ACHC). Please see their web sites at
http://www.aasmnet.org/ or http://www.achc.org/ for accreditation requirements.

Sleep studies performed outside a health care facility, i.e., home sleep studies, whether supervised,
attended, or not, are non-covered.

Billing Information Regarding Location of Service

Sleep labs located within a hospital or on the campus of a hospital (main campus, not offsite) should be
billed as an Institutional (UB-04) claim for all technical services. The physician doing the professional
work would submit a Professional (CMS-1500) claim. If the hospital has a sleep lab at an off campus
location (not on the main hospital campus) then it would qualify as a freestanding center (if it met all
other requirements of a sleep lab). Then the services should be billed as a Professional (CMS-1500) claim
and will be reimbursed a total global fee that would include all professional and technical components.
The Professional (CMS-1500) claim must be filed under the name and provider number of the PMD
interpreting physician. If a sleep lab is a freestanding center and meets all requirements, then the services
should be billed as a Professional (CMS-1500) claim and will be reimbursed a total global fee including
all professional and technical services. The Professional (CMS-1500) claim must be filed under the name
and provider number of the PMD interpreting physician. Coverage is subject to member’s specific
benefits.

Please see the list of Approved Hospital and Non-Hospital Based Sleep Centers/Laboratories

If you have any questions, contact your Network Services Representative. See
https://www.bcbsal.org/providers/contacts/networkServices.cfm.
                             Blue Cross and Blue Shield of Alabama

        Approved Hospital and Non-Hospital Based Sleep Centers/Laboratories

   Hospital-Based Facilities:

Andalusia Regional Hospital            Athens-Limestone Hospital             Baptist Hospital Pensacola
Sleep-Related Breathing Disorders      Sleep-Related Breathing Disorders     Sleep Disorders Center
849 So Three Notch St.                 Lab                                   1000 West Moreno Street
Andalusia, AL 36420                    700 West Market Street                Pensacola, FL 32522
334-222-8466                           Athens, AL 36512                      850-469-7042
                                       256-771-7378
Baptist Medical Center East            Baptist Medical Center-Princeton      Baptist Medical Center-South
Baptist East Sleep Disorder Center     Princeton Sleep/Wake Disorders        Sleep Disorders Center
6924 Winton Blount Drive               Center                                2105 East South Blvd
Montgomery, AL 36117                   701 Princeton Avenue SW               Montgomery, AL 36116
334-213-5051                           Birmingham, AL 35211                  334-286-3252
                                       205-783-7378
Baptist Memorial-Golden Triangle       Brookwood Medical Center              Bryan W. Whitfield Memorial
Baptist Memorial-Golden Triangle       Brookwood Sleep Disorders Center      Hospital
Sleep Lab                              2010 Brookwood Medical Center Drive   Bryan W. Whitfield Sleep
2520 5th Street North                  Birmingham, AL 35209                  Disorders Center
Columbus, MS 39705                     205-877-2403                          150 Highway 80 East
662-244-1552                                                                 Demopolis, AL 36732
                                                                             334-289-4000
Carraway Methodist Medical Center      Carraway Northwest Medical Center     Children's Hospital of Alabama
Sleep Disorders Lab                    Sleep Disorders Lab                   Sleep Disorders Lab
1600 Carraway Blvd                     1530 US Highway 43                    1600 7th Avenue South
Birmingham, AL 35234                   Winfield, AL 35594                    Birmingham, AL 35233
205-502-6164                           205-487-7000                          205-939-9334
Clay County Hospital                   Coosa Valley Medical Center           Crestwood Medical Center of
Clay County Hospital Sleep Disorders   Coosa Valley Sleep Disorders Center   Huntsville
Lab                                    315 West Hickory Street               The Crestwood Center for Sleep
83825 Hwy 9                            Sylacauga, AL 35150                   Disorders
Ashland, AL 36251                      256-249-5000                          1 Hospital Drive
256-354-2131                                                                 Hunstville, AL 35801
                                                                             256-882-3100
Cullman Regional Medical Center        DCH Regional Medical Center           Decatur General Hospital
Sleep Disorders Center                 Sleep Disorders Laboratory            Sleep Disorders Center
1912 Alabama Hwy 157                   809 University Boulevard East         1201 7th Street SE
Cullman, AL 35056                      Tuscaloosa, AL 35401                  Decatur, AL 35601
256-737-2140                           205-759-7333                          256-340-2558
DeKalb Regional Medical Center         East Alabama Medical Center           Eliza Coffee Memorial Hospital
The Sleep Disorders Center at DeKalb   Sleep Disorders Lab                   ECM Sleep Disorders Lab
RMC                                    2000 Pepperell Parkway                205 Marengo Street
200 Medical Center Drive               Opelika, AL 36801                     Florence, AL 35631
Fort Payne, AL 35968                   334-705-2404                          256-768-9153
256-845-3150
Flowers Hospital                        Floyd Medical Center                 Gadsden Regional Medical Center
Sleep-Wake Disorders Center             Sleep Disorders Center               Sleep Diagnostics of NE AL for
4370 W. Main Street                     Turner McCall Blvd                   Breathing Related Disorders
Dothan, AL 36302                        Rome, GA 30162                       1007 Goodyear Avenue
334-793-5000 x1685                      706-295-5500                         Gadsden, AL 35903
                                                                             256-494-4551
Grove Hill Memorial Hospital            Helen Keller Hospital                Huntsville Hospital
Grove Hill Sleep Solutions              Sleep Disorders Lab                  The Sleep Center at Huntsville
295 South Jackson Street                1300 S. Montgomery Avenue            Hospital
Grove Hill, AL 36451                    Sheffield, AL 35660                  911 Big Cove
251-275-3191                            256-386-4191                         Huntsville, AL 35801
                                                                             256-517-8553
Infirmary West at Knollwood             Highlands Medical Center             Jackson Hospital
Infirmary West Sleep Disorders Center   The Sleep Center at Jackson County   Jackson Hospital Sleep Disorders
5644 Girby Road                         380 Woods Cove Road                  Lab
Mobile, AL 36693                        Scottsboro, AL 35768                 1722 Pine Street
251-660-5757                            256-259-4444                         Montgomery, AL 36106
                                                                             334-293-8000

Jeff Anderson Regional Medical Center   Lakeland Community Hospital          L. V. Stabler Hospital
Sleep Disorder Center                   Lakeland Community Hospital Sleep    Greenville Sleep Center
2124 14th Street                        Services                             29 L. V. Stabler Drive
Meridian, MS 39301                      42024 Highway 195                    Greenville, AL 36037
601-482-8811                            Haleyville, AL 35565                 334-382-2676
                                        205-486-5213

Marshall Medical Center-South           Medical Center East                  Mizell Memorial Hospital
Breathing Related Sleep Disorders       Sleep Disorders Laboratory           Sleep Lab
Center                                  50 Medical Park Drive East           702 North Main Street
601-A Corley Avenue                     Birmingham, AL 35235                 Opp, AL 36467
Boaz, AL 35957                          205-838-3000                         334-493-3541
256-593-1226
Mobile Infirmary Medical Center          Monroe County Hospital Board         North Mississippi Medical Center -
Sleep Disorders Center                   Monroe County Hospital Sleep Lab    Iuka
5 Mobile Infirmary Circle                2016 S Alabama Ave                  Iuka Sleep Disorder Center
Mobile, AL 36607                         Monroeville, AL 36460               1777 Curtis Drive
334-435-5559                             251-575-3111                        Iuka, MS 38852
                                                                             662-423-6051
Northeast AL Regional Medical Center    Northport Hospital - DCH             Parkway Medical Center
Sleep Disorders Lab                     DCH Sleep Center                     Parkway Sleep Disorder Center
400 East 10th Street                    2700 Hospital Drive                  1874 Beltline Road SW
Anniston, AL 36207                      Northport, AL 35476                  Decatur, AL 35601
256-235-5077                            205-759-6179                         256-301-3342

Prattville Baptist Hospital             Providence Hospital                  Redmond Regional Medical Center
Prattville Baptist Sleep Disorders      Sleep Apnea Evaluation Lab           Sleep Disorders Center
Center                                  6801 Airport Blvd                    501 Redmond Road
124 South Memorial Drive                Mobile, AL 36685                     Rome, GA 30165
Prattville, AL 36067                    334-633-1000                         706-802-3955
334-365-0651
Riverview Regional Medical Center    Rush Medical Foundation           Russell Hospital
The Sleep Lab at Riverview           H C Watkins Memorial Hospital     Sleep Disorders Lab
600 S. 3rd Street                    605 S Archusa Ave                 3368 Hwy 280
Gadsden, AL 35901                    Quitman, MS 39355                 Alexander City, AL 35010
256-543-5200                         601-776-6925                      256-329-7100
Russellville Hospital                Vaughan Regional Medical Center   Shelby Baptist Medical Center
Russellville Hospital Sleep Center   Sleep Disorders Lab               Shelby Sleep Disorders Laboratory
15155 Highway 43                     1015 Medical Center Pkwy          1022 First Street North
Russellville, AL 35653               Selma, AL 36701                   Suite 501
256-332-1611                         334-414-4100                      Alabaster, AL 35007
                                                                       205-621-3737
Southeast Alabama Regional Medical   Springhill Memorial Hospital      St. Vincent's Hospital
Center                               Southeast Regional Center for     St. Vincent's Sleep Disorders
Sleep Disorders Center               Sleep/Wake Disorders              Center
1108 Ross Clark Circle SE            3719 Dauphin Street               810 St. Vincent's Drive
Dothan, AL 36301                     Mobile, AL 36608                  Suite 727
334-793-8711                                                           Birmingham, AL 35205
                                                                       205-930-2368
Thomas Hospital                      Troy Regional Medical Center      University of Alabama at
Thomas Hospital Sleep Services       Troy Sleep Disorders Center       Birmingham (UAB)
188 Hospital Drive                   1330 Highway 231 South            Sleep-Wake Disorders Center
Fairhope, AL 36532                   Troy, AL 36081                    1713 6th Avenue South
334-990-1940                         334-670-5000                      CPM Bldg., Room 270
                                                                       Birmingham, AL 35233
                                                                       205-934-7110
Walker Baptist Medical Center        Wayne Medical Center              West Florida Regional Medical
Sleep Disorders Lab                  Sleep EZ, LLC                     Center
3400 Hwy 78 East                     103 J V Mangubat Drive            Sleep Disorders Center at West
Jasper, AL 35501                     Waynesboro, TN 38485              Florida Hospital
205-387-4000                         931-722-5411                      8383 N. Davis Hwy
                                                                       Pensacola, FL 32514
                                                                       850-494-4850
Woodland Medical Center
Woodland Medical Center Sleep Lab
1910 Cherokee Avenue SW
Cullman, AL 35055
256-739-3500
   Non-Hospital-Based Facilities:

American Sleep Medicine                  CardioHealth Sleep Center of Auburn   Central Alabama Sleep Center
157 Resource Center Parkway #115         3700 Robert Trent Jones Trail         74011 Tallassee Highway
Birmingham, AL 35242                     Suite 325                             Wetumpka, AL 36093
205-408-7499                             Opelika, AL 36801                     334-286-6225
                                         334-737-4440
Enterprise Sleep Clinic                  Enterprise Sleep & Diagnostics        Foley Sleep Professionals, LLC
101 Professional Lane                    100-B Professional Lane               1819 N. McKenzie Street
Suite A                                  Enterprise, AL 36330                  Foley, AL 36535
Enterprise, AL 36330                     334-393-5555                          251-967-5337
334-347-3404
Lakeshore Sleep Disorder Center, LLC     Montgomery Sleep Solutions            Northwest Sleep Lab
1280 Columbiana Road                     8190 Seaton Place                     15225 Highway 43 Ste 2
Birmingham, AL 35216                     Montgomery, AL 36616                  Russellville, AL 35653-1929
205-945-4796                             334-396-9100                          256- 332-6363


Serenity Sleep Laboratory                Sleep Center of the Coast             Sleep Disorders Center of
1803 Park View Drive                     109 East Fern Avenue                  Alabama, Inc.
Cullman, AL 35058                        Foley, AL 36535                       790 Montclair Road
256-775-6550                             251-943-7800                          Suite 200
                                                                               Birmingham, AL 35213
                                                                               205-599-1020
Snows Sleep Center                       Southern Sleep Clinic                 Southern Sleep Clinic
701 University Blvd E                    210 N Edwards Street                  217 S Orange Avenue
Suite 707                                Enterprise, AL 36330                  Eufaula, AL 36027
Tuscaloosa, AL 35401                     334-393-0921                          334-687-4643
205-349-4043
Southern Sleep Clinic                    Southern Sleep Clinic                 Southern Sleep Clinics, LLC
160 S Painter Avenue                     515 S Three Notch Street              2346 West Main Street
Ozark, AL 36360                          Andalusia, AL 36420                   Suite 2
334-445-1421                             334-222-3305                          Dothan, AL 36301
                                                                               334-673-2501


The Rest of Your Life Sleep Evaluation
Center
1350 Summit Drive
Jasper, AL 35501
205-387-7900


   Last Updated: September 23, 2009

								
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