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95811

M
Wiki Split-Night downcoding

Hello, Is anyone experiencing issues with sleep medicine billing when a split-night study (95811) is ordered but does not meet split-night criteria? Many insurance companies are denying these claims and refusing to allow a downcode to a diagnostic study (95810). How are billers addressing this...
- myriamgaribay
- Thread
- Mar 4, 2025
- 95811 downcode downcoding 95810 split-night
- Replies: 0
- Forum: Billing/Reimbursement
M
Wiki Sleep Medicine Billing- Split night

Hello, Is anyone experiencing issues with sleep medicine billing when a split-night study (95811) is ordered but does not meet split-night criteria? Many insurance companies are denying these claims and refusing to allow a downcode to a diagnostic study (95810). How are billers addressing this...
- myriamgaribay
- Thread
- Mar 4, 2025
- 95810 95811 downcoding split-night
- Replies: 1
- Forum: Billing/Reimbursement
M
Wiki 95811

Normally we would bill a 95811 with a 52 modifier if there was less than 6 hours of recording. However, I have a new occurrence were we had zero sleep time recorded and the test was stopped at 78 minutes. Can we still bill for tech time an reduced services?
- myriamgaribay
- Thread
- Nov 11, 2021
- 95811 modifiers sleep modifiers sleep studies sleep study coding
- Replies: 0
- Forum: Medicare Regulations

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