On January 24, 2022, Medicare Administrative Contractor NGS announced that it would retire a local coverage determination (LCD) that barred coverage of certain central sleep apnea devices effective January 27, 2022.
Central sleep apnea occurs when the signaling between the brain and diaphragm is insufficient to stimulate regular breathing when a person is sleeping. Transvenous phrenic nerve stimulation has been shown to address this condition and the treatment had been covered for Medicare beneficiaries across the country, except those living in the jurisdiction of NGS.
Parrish Law Offices has represented a number of Medicare beneficiaries seeking access to a treatment for central sleep apnea. Parrish Law Offices helped a Medicare beneficiary file a challenge against the non-coverage LCD. NGS’ January 24, 2022, announcement comes on the heels of a December finding by a Medicare administrative law judge (ALJ) that the LCD record did not support the validity of the LCD under the “reasonableness standard” and approval of discovery related thereto against NGS. The retirement of an LCD has the same effect as a judicial ruling that the LCD was invalid. Thus, the retirement of the LCD by NGC represents a complete victory for the client.
Parrish Law Offices’ most recent win is its latest in a string of successful LCD challenges across a wide range of technologies.