What are some tips to Coding and Reimbursement for Home Sleep Testing?
It is important to be informed on the coverage, contracting, coding and reimbursement requirements of payors when considering offering home sleep testing within your practice. As payor policies are constantly evolving with respect to home sleep testing, this serves as a guide to help you navigate the key issues with your payor set.
The information below provides an overview of CPT® coding applicable to unattended sleep studies for a patient suspected of having sleep apnea. When selecting a CPT code, healthcare providers should choose the code that most accurately identifies the procedure or service performed.
CPT Code 95800
Sleep study, unattended, simultaneous recording: heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time.
CPT Code 95806
Sleep study, unattended, simultaneous recording of heart rate, oxygen saturation, respiratory airflow and respiratory effort.
HCPCS Code G0399
Home sleep study with Type III portable monitor, unattended; minimum of four channels: two respiratory movement/airflow, one ECG/heart rate and one oxygen saturation.
What are commonly used ICD Codes for Type III Home Sleep Test/ Home Sleep Study?
|Obstructive sleep apnea
|Sleep-related hypoventilation/hypoxemia in conditions classified elsewhere
|Insomnia with sleep apnea, unspecified
||G47.01 and G47.33
|Hypersomnia with sleep apnea, unspecified
||G47.14 and G47.33
|Unspecified sleep apnea
To determine exact reimbursement amounts for your state, CLICK HERE Enter the appropriate code from the list above and select your state to find reimbursement amounts.
What are Clinical Guidelines for Type III Home Sleep Test?
CMS (Center for Medicare and Medicaid) Guidelines:
Home sleep test (HST) with Type III portable monitor, unattended with a minimum of 4 channels. Type III devices must include the following channels:
- 2 respiratory movement/airflow
- 1 ECG/heart rate
- 1 oxygen saturation
(HCPCS #G0399, CPT 95806)
Monitoring devices do not record the signals needed to determine sleep stages or sleep disruption. Typically channels include:
4 physiologic variables are measured including:
- 2 respiratory variables
(eg, respiratory movement and airflow)
- 1 Cardiac variable
(eg, heart rate or an electrocardiogram)
- 1 Arterial oxygen saturation
Some devices may have other signals including a monitor to record snoring, detect light, or a means to determine the body position.
CleveMed’s SleepView is the smallest, lightest home sleep apnea monitor meeting clinical guidelines.
SleepView Clinical Validation
Home Sleep Study Decision Tree (PDF)
What is the New Home Sleep SCOPER Classification System?
A new classification system detailing the type of signals measured by home sleep testing devices for diagnosing obstructive sleep apnea (OSA) appeared in the latest issue of the Journal of Clinical Sleep Medicine. The proposed system categorizes home sleep testing devices, called out-of-center (OOC) testing devices in the paper, based on measurements of Sleep, Cardiovascular, Oximetry, Position, Effort, and Respiratory (SCOPER) parameters. Criteria for evaluating the devices are also presented, based on pre-test and post-test probabilities.
“Obstructive Sleep Apnea Devices for Out-Of- Center (OOC) Testing: Technology Evaluation” Journal of Clinical Sleep Medicine, Volume 07 No. 05, 2011
READ MORE ABOUT SCOPER
CleveMed’s SleepView® [home sleep monitor] meets SCOPER guidelines with the following scores:
Sleep – 3*
Cardiovascular – 4
Oximetry – 1
Position – 2
Effort – 2
Respiration – 1
*(with web portal)
Home Sleep Testing White Papers and Publications
PRIMARY CARE AND SLEEP APNEA TESTING: A PILOT STUDY FOR HOME TESTING
by Thomas D. Schwieterman MD, Hani Kayyali, Kirk Scovill
Patients with OSA are at significantly higher risk for developing hypertension, diabetes, heart disease, obesity and sudden death. Despite a high prevalence for OSA in all primary care practice populations, too few patients are screened for the disorder and fewer are tested. The gold standard and most common modality for achieving a diagnosis for OSA has traditonally been the in-lab polysomnogram (PSG). Yet, home sleep testing equipment and methodologies have been shown to be of comparable efficacy, are lower cost and can be effectively administered by primary care physicians.
READ WHITE PAPER
HOME SLEEP TESTING CAN IMPROVE PATIENT CARE
by Sarah Weimer (PDF as seen in Sleep Diagnosis and Therapy Magazine)
The changing reimbursement and acceptance of home sleep testing by insurance payers and sleep professionals will open up opportunities for improved patient care and will provide sleep labs with a means to expand the reach of their sleep services. Many patient populations are well suited for home sleep diagnostic testing…
SELF-ADMINISTERED WIRELESS MONITOR FOR COMPREHENSIVE EVALUATION OF CPAP BENEFIT IN THE HOME
by Hani Kayyali (as seen in Sleep Diagnosis and Therapy)
…Effective treatment exists; however, once prescribed therapeutic benefit is not monitored adequately. Many patients, especially those with comorbidities, may require pressure adjustments, supplemental therapy, or different intervention that maybe difficult to identify with current therapy assessment techniques….
Can I try Home Sleep Testing at my practice?
Yes, you can!
SleepView is the smallest, lightest home sleep monitor utilizing traditional sleep lab methodology. Meets AASM guidelines to assess sleep disordered breathing. SleepView Web Portal is HIPAA compliant and allows seamless, secure access to patient’s raw sleep data for scoring and interpretation. There are several options available to you. Call 877-CLEVEMED to talk with us!