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
|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).
|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)
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.
|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.
|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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