News
Prior Authorization and Sleep Studies
Date: 06/15/16
Ambetter from Sunshine Health understands the importance of easy access to care. So, we are committed to ensuring our prior authorization requirements continue to be appropriate and efficient.
Effective September 15, 2016, home-based sleep studies will no longer require prior authorization. The codes affected by this change include:
| Code | Description |
|---|---|
| 95800 | Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis(e.g., by airflow or peripheral arterial tone), and sleep time |
| 95801 | Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone) |
| 95806 | Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, unattended by a technologist |
| G0398 | Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation |
| G0399 | 9 Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen |
| G0400 | Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels |
To avoid claim denials, please refer your Ambetter patients to a participating provider to read the results of home-based sleep studies.
If you have any questions, please reach out to Provider Services at 1-877-687-1169. And, thank you for partnering with Ambetter from Sunshine Health.