Medicare Compliance & Reimbursement

Question: Can we bill G0399 and 95806-26 together on the same claim? One of our providers says we can state G0399 is the “equipment code” while 95806-26 covers the physician’s interpretation of the study.

Massachusetts Subscriber

Answer: You cannot bill the codes on the same claim as you’ve assigned them in your question. Codes 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) and 95806 (Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement)) cover the same service, but G0399 is a HCPCS Level II code that is used to bill Medicare and Medicaid.

Simultaneously, G0399 has a PC/TC Indicator of 1 in the Medicare Physician Fee Schedule. This means that the G code can be billed for the global service without a modifier, or you can append modifier TC (Technical component) or 26 (Professional component) to bill for either component, but with caution.

In your scenario, “You would be double dipping on the professional component because G0399 billed without a modifier is the global billing, which includes the technical and professional component. Then billing 95806-26 is billing a second time for the professional component of an unattended sleep study,” says Corinne A. Littleton, CPC, commercial insurance compliance specialist in Meridian, Idaho.

The National Correct Coding Initiative (NCCI) also prevents these two codes from being reported together.