CQW Panacea-re-brand-rev3

Respiratory

For the Week of April 14, 2014

Question:

We are discussing the PAP nap sleep study procedure at one of our hospitals and would like your advice about billing this with 95807-52.

Answer:

Based on the payer reimbursement and coverage guidelines that we have read, the study is considered investigational and / or unproven as a diagnostic study. Some payers consider the study to be an inherent component of the initial qualifying study and transition to CPAP and fitting and not separately billable.

Other payers, such as Cigna, do reference CPT code of 95807-52 for reduced services, but we are reluctant to suggest use of this code for this procedure. However, there is not an alternative for an unlisted CPT within the subsection for sleep medicine. If billing for the PAP nap with 95807-52, it is, of course, recommended that the payer guidelines for investigational or experimental claims submission be adhered to, when applicable.

 

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