AAPC - Back to school
Results 1 to 6 of 6

Thread: Coding an incomplete cpap titration 95811

  1. #1

    Default Coding an incomplete cpap titration 95811

    AAPC: Back to School
    Does anyone know how to code a cpap titration (95811) when the patient was unable to sleep? The test continued for over 6 hours. Medicare requires that the patient sleep at least 2 hours. The patient wants to return and try again.

    My thoughts are either a modifier 52 for reduced services or tc for tech time.


  2. #2
    Join Date
    Apr 2007


    I would append a modifier 52 to the claim (are you billing for both the report and tech time? - if so put a modifier 52 on the claim.

  3. #3

    Default Two modifiers?

    Since the test did not complete, there will be no report. The test will be redone. In addition to modifier 52, maybe I should also code with modifier TC for the tech time?

  4. #4
    Join Date
    Apr 2007
    Leesburg, VA


    I'm not sure what Medicare carrier you deal with, but Highmark will usually request records on a sleep study w/ a 52 modifier. Our experience has been that if there isn't enough data to produce a report they won't pay, even a reduced amount. A TC would probably be your best bet, but if you want to utilize the 52 or 52:TC you are probably going to have to file an appeal.

    Good Luck!

  5. #5

    Default HELP PLS. sleep studies

    We want to have a sleep study clinic here in our office/I know nothing regarding sleep studies. My physician asked me "how much does MC reimburse for a CPAP machine?" I have no clue, I dont even know where to start. Do we buy our own to do the testing and bill for the testing? Not the actual machine? I need HELP

  6. #6

    Default HELP PLS. sleep studies

    email me at my login name but please titile it accordingly so I can recognize it

Similar Threads

  1. Coding of billing for CPAP repair
    By shaitan55339 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 04-14-2014, 02:35 PM
  2. sleep study 95810-95811 - I tried posting this
    By herrera4 in forum Billing/Reimbursement
    Replies: 0
    Last Post: 07-02-2012, 07:36 AM
  3. Oxygen titration
    By brodel in forum E/M
    Replies: 0
    Last Post: 11-16-2010, 09:14 AM
  4. Home CPAP auto titration coding
    By B Seyer in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 11-13-2007, 11:21 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.