Wiki POS Home Sleep Study

[michelle.mcguinn@nghs.com]

We have been getting denials from Medicare for the global charge for CPT 95800 being billed with a place of service 12. All Medicare will say when we call is that the POS 12 is incorrect and to reference our LCD (A56995) in the Group 4 paragraph it says "the office-based technician doing the patient instruction and HST scoring meet the training/credentialing requirements as outlined in the LCD." So does that mean that insurance wants CPT 95800 to be billed with a POS 11? That contradicts the CMS manual that says the POS should be where the technical portion is preformed. Any guidance on this would be much appreciated.

 

[TJAlexander]

Maybe it's the wording of the CPT code saying 'unattended'. I thought that the test itself was a 'G code.

 

[tch678]

I just got off the phone with Medicare. The issue is with the address in box 32. Because box 32 populates the patient's home address because of pos 12, the zip code has to be within a short distance of the Provider. For example, my provider is in California but the patient's address is in Idaho because they split there time between the two states, Medicare didn't like that the zip code was so far away.