Billing and Coding: Outpatient Sleep Studies

Outpatient sleep studies are covered when they meet the reasonable and necessary clinical criteria in Novitas LCD L35050; home WatchPAT tests should be billed with CPT 95800 or 95801. Actigraphy can be reported with CPT 95803 for CPAP documentation or for follow-up CPAP only if accepted by the DME contractor, but interpretation payment for 95803 will not be paid separately and all coding is subject to NCCI edits.

"Outpatient sleep studies that meet the reasonable and necessary clinical criteria in Novitas LCD L35050 are covered."

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