Billing and Coding: Polysomnography and Other Sleep Studies

Medicare covers facility-based polysomnography (CPT 95808/95810/95811) and home sleep testing (G0398/G0399/G0400) when appropriate documentation and clinical indications are met: PSG must be performed in a facility-based lab, and HSTs must be done after a comprehensive sleep evaluation in patients with a high pretest probability of moderate to severe OSA. Documentation requirements include physician orders, assessment, test parameters, device and provider qualifications for HSTs, and justification for more than one HST per year or more than two PSGs per year; MSLT (95805) is billed as one unit per single-day test.

"Home sleep tests (G0398, G0399, G0400) are covered when performed in conjunction with a comprehensive sleep evaluation and the patient has a high pretest probability of moderate to severe obstructi..."

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