Sleep Medicine Codes 2017-09-19T17:26:25+00:00

Sleep Medicine Codes

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

CPT Codes Description
95782 Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
95783 Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist
95800 Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
95801 Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
95803 Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
95805 Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
95806 Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement)
95807 Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
95808 Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist
95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
95811 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist
94660 Continuous positive airway pressure ventilation (CPAP), initiation and management

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).

CPT Code Description
99201 Level 1 new patient office visit
99202 Level 2 new patient office visit
99203 Level 3 new patient office visit
99204 Level 4 new patient office visit
99205 Level 5 new patient office visit
99211 Level 1 established patient office visit
99212 Level 2 established patient office visit
99213 Level 3 established patient office visit
99214 Level 4 established patient office visit
99215 Level 5 established patient office visit

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)

As of March 13, 2008, CMS requires HSATs to be coded using G-Codes for Medicare beneficiaries

Code Description
G0398 Home sleep study test (HST) with type II portable monitor; unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort, and oxygen saturation
G0399 Home sleep test (HST) with type III portable monitor; unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
G0400 Home sleep test (HST) with type IV portable monitor; unattended; minimum of 3 channels

Durable Medical Equipment (DME) Sleep Medicine Codes

All E codes fall under the jurisdiction of the DME MAC unless otherwise noted.

Code Description
E0485 Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment
E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment
E0601 Continuous positive airway pressure (CPAP) device
E0470 Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g. nasal or facial mask (intermittent assist device with continuous positive airway pressure device)
E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g. nasal or facial mask (intermittent assist device with continuous positive airway pressure device)

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