G47.59 — Other parasomnia
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
- Supporting documentation must demonstrate that CPT 31720 was personally performed by the physician or qualified NPP when billing that code.
- For consecutive days of respiratory therapy, the medical record must document why the patient was not transferred to a higher level of care.
- Claims must document medical necessity and meet the reasonable and necessary requirements specified in Novitas LCD L35050.
Key Coverage Criteria
- CPT 94762 is medically necessary when intermittent arterial blood gas sampling is likely to miss important variations in the patient's respiratory status.
- CPT 94762 is medically necessary when the patient has hypoxemia and there is a need to assess supplemental oxygen requirements and/or a therapeutic oxygen regimen.
- Outpatient sleep studies that meet the reasonable and necessary clinical criteria in Novitas LCD L35050 are covered.
- Home sleep testing performed with a WatchPAT device should be billed with CPT code 95800 or 95801.
- Actigraphy may be reported with CPT code 95803 to document CPAP coverage under the applicable NCD or as follow-up CPAP administration when accepted by the DME contractor.
- Unattended sleep studies billed with HCPCS G0398, G0399, G0400 or CPT 95800, 95801, 95806 are covered when the study meets the narrative definition of the respective code (i.e., is performed without a technologist present).
11 Active Policies
A57496 — Billing and Coding: Polysomnography and Sleep Testing
J09
L33405 — Polysomnography and Sleep Testing
J09
A56923 — Billing and Coding: Outpatient Sleep Studies
J12
L35050 — Outpatient Sleep Studies
J12
L34417 — CT of the Head
Related Codes
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