Current Procedural Terminology (CPT®) Codes
The CPT code set is a uniform coding system consisting of descriptive terms and identifying codes (5 numeric digits) that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. The CPT code set is maintained by the American Medical Association (AMA) and decisions regarding addition, deletion or revision of CPT codes are made by the CPT Editorial Panel. Although not all-inclusive, the below tables list some of the more frequently used codes in sleep medicine.
Sleep Services Codes
Note: Use the Technical Component (TC) modifier when only the technical component is billed and the 26 (professional component) modifier when only the professional component is billed.
Evaluation and Management (E/M Codes)
Sleep physicians also use Evaluation and Management codes to bill for office visits. Assigning codes for office visits can be complex, however, Medicare has an Evaluation and Management Services guide you can refer to for more information.
Evaluation and management codes are restricted to physicians and other qualified advanced nurse practitioners (NPs, PAs, etc.). Technologists cannot bill independently but they can bill incident to the physician (if certain guidelines are followed).
Find more information about the E/M Code Changes, here.
Healthcare Common Procedural Coding System (HCPCS)
HCPCS is divided into two subsystems: Level I (comprised of the CPT code set) and Level II. Level II of the HCPCS is a standardized coding system (a single alphabetical letter followed by 4 numeric digits) that is primarily used to identify products, supplies and services not included in the CPT code set. HCPCS Level II codes include ambulance services and durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) when used outside a physician’s office.
G Codes (home sleep apnea testing)
The G codes (G0398, G0399 and G0400), which describe home sleep apnea testing (HSAT) services, were added to the Healthcare Common Procedure Coding System (HCPCS) Level II in 2008. Some insurers accept the G codes while others accept the CPT® codes for HSATs (95800, 95801 and 95806). An HSAT provider will need to contact each insurer they work with to identify which codes can be reported.
Durable Medical Equipment (DME) Sleep Medicine Codes
All E codes fall under the jurisdiction of the DME MAC unless otherwise noted.
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