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Wiki Medicare and Highmark Blue Shield Denials for 95810, Polysomnography; age 6 years+, sleep staging with 4 or more additional parameters of sleep

Thread starter rothja01
Start date Aug 29, 2024

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rothja01

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Aug 29, 2024

Hello, Has anyone been receiving denials for CPT 95810 both on the professional and facility claims for this code from Medicare or Highmark BS? We are seeing FACILITY denials for missing/invalid principal procedure and for PROFEE the denials are 16 - Lacks info for adjudication. The diagnosis codes that have been assigned are meeting medical necessity. Anyone have any insight?

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