Billing and Coding: Polysomnography and Other Sleep Studies

Coverage for polysomnography and other sleep studies follows the indications and documentation requirements in LCD L36839; diagnostic testing is covered when patients present with the symptoms or complaints listed in that LCD. Ordinarily one PSG/EEG is sufficient to diagnose OSA, up to three MSLT naps confirm narcolepsy (CPT 95805 counts all naps as one unit), and routine limits apply (generally ≤1 HST/year and ≤2 PSGs/year); additional studies beyond these limits require persuasive medical evidence of medical necessity.

"Diagnostic polysomnography or other sleep testing is covered when the patient has symptoms or complaints of one of the conditions listed in LCD L36839."

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