Neurology & Pain Management Coding Alert

Question: Must a technician be in constant attendance to bill for a complete sleep study?

Mississippi Subscriber

Answer: Yes, the technician must be in constant attendance during sleep study to receive reimbursement. Medicare and most third-party payers will only pay for 95807 (Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist), which includes constant attendance. A physician must interpret the results the technologist provides. The technologist will generally note the patient's position during sleep
 
CMS denies medical necessity for unattended sleep study code 95806 (Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, unattended by a technologist) and will not pay for the procedure.
 
Place of service affects sleep study reimbursement. Medicare guidelines specify that "Medically necessary diagnostic studies for sleep disorders, including polysomnography, sleep staging and sleep latency tests, must be performed in an approved sleep center. Medicare considers portable sleep studies (95806), sleep studies without professional attendance in the home setting, and sleep studies that measure and record limited characteristics of the patient's sleep experimental/investigational" and does not cover these services.