Sleep Testing

July 26th, 2017 - Chris Woolstenhulme, CPC, CMRS
Categories:   Dental   Oral and Maxillofacial Surgery   Coding  
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Once a patient has been evaluated for symptoms associated with sleep apnea, testing is ordered to identify severity and determine treatment.

There are several types of sleep tests, but coverage is based on meeting the criteria for Type I (inpatient facility based) or Type II-IV and Other (home-based sleep tests). All sleep tests require interpretation by a practitioner who holds specific credentials. (See LCD33718).

Type of sleep test and requirements for each are as follows:

Type I Device - Facility based

  • Continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep with practitioner review, interpretation, and report.
  • Includes sleep staging (defined as a 1-4 lead electroencephalogram (EEG), electro-oculogram (EOG), submental electromyogram (EMG) and electrocardiogram (ECG).
  • Must contain the following parameters of sleep: airflow, respiratory effort, and O2 saturation by oximetry.
  • May be a whole night study or a split night study
  • Performed to diagnose and initially evaluate treatment

TIP: Even though the patient may be staying the night in an ambulatory care center, freestanding clinic, or even the hospital, the sleep study is NOT considered an inpatient service. 

Home Sleep Test (Types II-IV, and Other Devices)

  • Type II: Monitors and records a minimum of (7) channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory movement/effort and oxygen saturation
  • Type III: Monitors and records a minimum of four (4) channels: respiratory movement/effort, airflow, ECG/heart rate and oxygen saturation; or,
  • Type IV: Monitors and records a minimum of three (3) channels, one of which is airflow
  • Other: Devices that monitor and record a minimum of three (3) channels that include actigraphy, oximetry and peripheral arterial tone and for which there is substantive clinical evidence in the published peer-reviewed medical literature that demonstrates that the results accurately and reliably correspond to an AHI or RDI as defined above. This determination will be made on a device by device basis.

Special Instructions on HST Devices: Prior to the test, the patient must be instructed on how to properly apply a portable sleep monitoring device (provided by the entity conducting the HST and NOT the DME supplier) either face-to-face or via video or telephonic instruction with 24-hour access for inquiries and troubleshooting.

Locations for Sleep Studies
Type Code(s) Approved Place of Service

Sleep Studies

95800
95801
95803
95805
95806
95807

11 = Independent diagnostic testing facility (IDTF) or facility-based sleep laboratory 

24 = Ambulatory Surgical Center
Polysomnography 95808
95810
95811

11 = Independent diagnostic testing facility (IDTF) or facility-based sleep laboratory

24 = Ambulatory Surgical Center
Home Sleep Testing (HST) G0398
G0399
G0400

12 = Home

15 = Mobile independent diagnostic testing facility

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