Sleep Medicine Reimbursement

Arnold, MO
Best answers
I am trying to get information on reimbursement on CPT codes

95810 – Adult in lab test
95811 – Adult in lab test

95806- Home sleep test

As related to the changes that the American Academy of Sleep Medicine (AASM) has made and whether Medicare, and other insurance carriers, honor these rules when it comes to reimbursement. The two big changes in question:
1. Home sleep tests now using the Respiratory Event Index (REI) instead of the Apnea/Hypopnea Index (AHI) to determine severity. NOTE: this only pertains to the home sleep test. In lab testing will continue to use the AHI.
2. Scoring criteria for an obstructive event changing from a 4% blood oxygen desaturation to a 3% blood oxygen desaturation.

If we can start using the 3% rule to score respiratory events it will also help speed up turnaround time. Right now we are scoring both (3% and 4% respiratory events) for our doctors and reporting those in separate indices. It takes more time to do this so if we can use one rule it should speed the process up.

Any advice or help is welcome.

Thank you,
Heather, CPC, CRC