Sleep Studies: Billing with Reduced Hours

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
January 12th, 2017

When using codes 95800, 95801, 95806, 95807, 95810, and 95811, and fewer than six hours of recording is performed, you must report the reduced services using modifier 52.

Also, when using 95782 and 95783, and fewer than seven hours of recording is performed, modifier 52 would be appended to the appropriate code.

95805 would require modifier 52 if fewer than four hours of recording is performed.

Medicare recognizes the performance of multiple nights of Home Sleep Testing (HST) as one (1) study. The performance of multiple night testing has been shown to address (a) night-to-night variability, (b) first night effect, and (c) failed studies. However, as multiple night testing is performed as part of a single episode of testing, HST will be paid as one (1) unit regardless of the number of multiple nights of patient data obtained to successfully and appropriately complete the testing.

HST services are reported with procedure codes G0398, G0399, and G0400 as appropriate with a unit of one (1) for the entire episode of testing. The date of service is reported as the date the study is completed.

“Split-night” services (initial diagnostic polysomnography (PSG) followed by continuous positive airway pressure (CPAP) titration during PSG on the same night) that last at least 6 hours are to be reported with procedure code 95811. “Split-night” services less than 6 hours are to be reported as 95811 with the modifier -52.

References:

• Sleep Disorders Testing (A50380)