Question G0399 vs. 95806

[sharonvalwa]

What is the difference between the two codes G0399 and 95806? I have a provider that bills G0399 the day the patient takes home the equipment. The biller then bills 95806-26 the day the physician reads the study - they say it's because the G0399 is the equipment, but from what I have read, it appears to also be a sleep study, just typically a Medicare/Medicaid code - any insight on this?

 

[CBLENNIE]

G0399-Home sleep test (HST) with type III portable monitor, unattended, has a PC/TC Indicator of 1, meaning the code has a technical & professional component. G0399 can be bill for the global services without a modifier or can be billed for the technical component only using modifier TC (G0399-TC) and for the professional component only with modifier 26 (G0399-26)

So, it would be inappropriate to bill G0399, which is the global procedure for this service, followed by 95806-26 for the professional component of a sleep study. 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 and then billing 95806-26 is billing a second time for the professional component of an unattended sleep study.

 

[sharonvalwa]

G0399-Home sleep test (HST) with type III portable monitor, unattended, has a PC/TC Indicator of 1, meaning the code has a technical & professional component. G0399 can be bill for the global services without a modifier or can be billed for the technical component only using modifier TC (G0399-TC) and for the professional component only with modifier 26 (G0399-26)

So, it would be inappropriate to bill G0399, which is the global procedure for this service, followed by 95806-26 for the professional component of a sleep study. 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 and then billing 95806-26 is billing a second time for the professional component of an unattended sleep study.

View attachment 7200

Thank you, I see the indicator of 1 now in Encoder, appreciate that.