Monday, March 31, 2008

Local Coverage Decision for Home Testing for OSA

The local coverage decisions that will implement Medicare coverage for home testing are starting to come out. The following "Future LCD" appears to cover Indiana, New Jersey, New York, and Kentucky:
The diagnosis of sleep apnea may be made using the following modalities:
polysomnography (PSG) performed in a sleep laboratory; or
unattended home sleep monitoring device of Type II; or
unattended home sleep monitoring device of Type III; or
unattended home sleep monitoring device of Type IV, measuring at least three channels (CAG-00093R2)


CPT code 95806 (unattended sleep study) by definition involves the absence of a technologist. Unattended sleep studies must meet the CPT definition in order to bill CPT code 95806.
95806
SLEEP STUDY, SIMULTANEOUS RECORDING OF VENTILATION, RESPIRATORY EFFORT, ECG OR HEART RATE, AND OXYGEN SATURATION, UNATTENDED BY A TECHNOLOGIST


I expect LCD's covering other regions to be similar. The bottom line is that Type 4 devices can be used to diagnose osa and obtain coverage for cpap, but there is no reimbursement for the actual study. The reimbursement for a type 3 study (95806) is about $200.

4 comments:

landon said...

I dont know how much the actual reimbursement is with a Type IV, but it CAN be billed as 95806 with a -52 reduced services modifier code. I would assume that it would be similar to other -52 modifiers where they will pay with a 40-50% reduction from standard fees.

Michael Rack, MD said...

landon, thanks for the billing tip.
I usually use the -52 modifier when a sleep study is cut short. I didn't know it could be used in the way you are describing.

Alex said...

I APPRECIATE any info, link, phone number, email, connection that can help me with this question:
I am about to buy a WATCH-PAT 100.
As of today:
1)How do I code for it? Billing codes for Medicare, and privates!( I heard medicare is designating a G code.
2)Does Medicare pay for it?
3)what are the diagnostic codes? for medicare And Pivate insurance and how much they pay?

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