Sleep Testing – 2013 Updated Payment Information and New Pediatric Sleep Codes

2013 Updated Payment Information

The 2013 Medicare Physician Fee Schedule (MPFS) final rule was published on Nov.16, 2012. Since that time, as a result of the American Taxpayer Relief Act enacted on Jan. 2, 2013, the conversion factor rate used to calculate payment for services has been updated. As a result of the Act, the 26% SGR cut was averted and the 2% sequestration cut was delayed for 2 months. The new 2013 conversion factor rate is $34.0230. Payment for all services in the MPFS is calculated by multiplying the relative value units (RVUs) assigned to each component of the service by the designated conversion factor for the year. Medicare 2013 national payment for sleep services is described in the chart below.

Code

Descriptor

2012 Total RVU

2013 Total RVU

RVU Difference

National Payment

95800

Sleep study, unattended w/ sleep time

4.73

5.37

+ 12%

$182.70

95801

Sleep study, unattended

2.54

2.80

+ 9%

$95.26

95803

Actigraphy testing

4.86

4.48

– 8%

$152.42

95805

MSLT/MWT

12.27

12.62

+ 3%

$429.37

95806

Sleep study, unattended w/ respir effort

5.40

5.39

$183.38

95807

Sleep study, attended

14.64

14.69

$499.80

95808

PSG, 1-3 additional parameters

19.73

19.23

– 3%

$654.26

95810

PSG, 6 yr or older, 4 or more additional parameters

19.47

18.99

– 3%

$646.10

95782

PSG, under 6 yr, 4 or more additional parameters

NA

31.35

NA

$1066.62

95811

PSG, 6 yr or older, 4 or more additional parameters w/ PAP

20.76

19.92

– 4%

$677.74

95783

PSG, under 6 yr, 4 or more additional parameters w/ PAP

NA

32.83

NA

$1116.98

Pediatric Sleep Codes

New to the 2013 Physician Fee Schedule are two codes describing pediatric polysomnography. These codes are approved for patients under age 6. Patients who are age 6 and older are billed for using the previously existing polysomnography codes (95810 and 95811). The new codes are as follows:

  • 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

Members with questions about 2013 payment or proper use of the new pediatric sleep codes should contact the AASM at coding@aasm.org.

2013-02-05T00:00:00+00:00 February 5th, 2013|Clinical Resources|