Home Sleep Study prior to Overnight in Lab Denials

MeBriggs

Networker
Messages
31
Location
Northeast Kansas
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0
My providers are currently sending patient's who have clinical high risk symptoms of OSA without comorbid conditions home with Star Dust, a home sleep study with 3 channels. This codes to either 95801 or G0400. When these come back showing >5 AHI (interrupted sleep) then they send them for the full Overnight Sleep Study (95806). However, if they have previously billed the 95801, they receive denials on prior auths for the 95806. Is anyone else having this issue? Want payors to understand that the Star Dust is a tool to aid in the dx of OSA, but it's not definitive and the overnight sleep is still needed.
 
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