95806--help with portable sleep tests


Pittsburgh Central Pennsylvania
Best answers
Our neurologist does the readings for a variety of tests, one of which is a 95806. We are having some trouble with the carriers because of the place of service we bill--since our doc is only READING the tests we were billing a place of service-outpatient hospital- our Medicare contractor denied payment and told us a 22 place of service is not correct for the code.

I believe, from what the doctor explained to me, that the patient goes to the hospital to pick up the equipment and receive instructions on using the equipment and then actually uses the equipment at home. Would a place of service 12 be plausible for this situation?

Any suggestions are appreciated!

Thank you.


Midlothian, VA
Best answers
Beth -

We've struggled with this as well. I'm in a Pulmonary/Sleep/Critical Care practice. Our Medicare contractor is Trailblazer and they don't except 95806 and we've had to bill with G0398 - G0400. I don't know if that situation applies to you or not?
Our physicians are reading these in the office so we bill with POS 11. The professional component is all we are billing and using mod 26 and POS 11.
Are you using the 26 mod and POS 22?
I would also check how your Medicare contractor wants you to bill professional components. Trailblazer specifies that no matter where the reading was done (home, hotel, hospital, office, etc) that's the POS we have to use. Does your contractor have a policy like that?

I don't know if any of that helped?