News
Effective April 1, 2025: Removal of Prior Authorization Requirement for Certain Sleep Studies
Date: 03/24/25
Effective April 1, 2025, Superior HealthPlan will no longer require prior authorization for certain procedures related to Sleep Studies.
For all Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP and Ambetter from Superior HealthPlan members, Superior will no longer require prior authorization for the following Current Procedural Terminology (CPT) codes:
| CPT Codes | Description |
|---|---|
| 95800 | Sleep Study, Unattended |
| 95801 | Sleep Study, Unattended with Analysis |
| 95806 | Sleep Study (Vent-Resp-ECG-O2 Sat, Unattended) |
| G0398 | Home Sleep Test, Type II Portable |
| G0399 | Home Sleep Test, Type III Portable |
| G0400 | Home Sleep Test, Type IV Portable |
For Medicaid, CHIP and Ambetter members 17 years of age and younger, Superior will no longer require prior authorization for the following CPT codes:
| CPT Codes | Description |
|---|---|
| 95803 | Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording) |
| 95805 | Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness |
| 95807 | Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist |
| 95808 | Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist |
| 95810 | Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist |
| 95811 | Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist |
To review prior authorization requirements, please visit Superior’s Prior Authorization webpage.
For questions or additional information, contact Superior’s Prior Authorization department at 1-800-218-7508.