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.
