The American Academy of Sleep Medicine recently sent a letter to Wellmark to raise concerns about a payer policy affecting reimbursement for inlab diagnostic and titration sleep studies. The policy restricts reimbursement for Current Procedural Terminology (CPT) codes 95810 (diagnostic polysomnography) and 95811 (polysomnography with PAP titration) when billed within 30 days of each other.
In the letter, AASM outlined that CPT codes 95810 and 95811 represent distinct tests performed for different clinical purposes and that established AASM clinical practice guidelines do not require a specific time interval between a diagnostic polysomnogram and an inlab titration study.
Given the recurring nature of this issue, AASM has developed a template letter for members that can be personalized and submitted directly to other payers. The template helps members:
- Support payer outreach at the local and regional level
- Reinforce the clinical distinction between diagnostic and titration studies
- Align payer policies with evidencebased sleep medicine practice
Members are encouraged to customize the letter with payerspecific details and submit it as part of their ongoing payer engagement efforts.
Questions about this template letter can be sent to coding@aasm.org.
