Home Sleep Studies Gets a New CPT Code

First approved in 2008, unattended home sleep studies now have been assigned a permanent CPT code.  Historically, sleep studies have been performed during an overnight stay in a hospital or a lab, but new technology has allowed physicians to prescribe unattended sleep recordings of a patient’s heart rate, oxygen saturation, and respiration in a home environment. This is great news since an estimated 50 to 70 million American have a sleep disorder, and if left untreated, sleep disorders can have serious affects on a patient’s health.

In 2011, CMS issued a final rule that assigned home sleep studies to CPT codes 95800 (sleep study, unattended simultaneous recording, heart rate, oxygen saturation, respiratory analysis, and sleep time) and 95801, which monitors the same parameters except sleep time.  For providers, these codes translated to APC 0213 (Level I Sleep Studies, $167).  Overnight hospital laboratory-based studies fall under APC 0209, which is reimbursed at a considerably higher rate of $782.

$782 verses $167 is a big difference.  So, what’s in it for the patient?  Laboratory-based testing has been deemed the gold standard.  But on the other side, a full polysomnography is impractical for long-term (multiple days) and home utilization.  Studies comparing basic parameters indicated that attended tests had a 1.5% chance of having a poor quality recorded verses 4.7% for unattended studies.  But, from a patient satisfaction point of view, 67% of patients preferred home-based.

What does the American Academy of Sleep Medicine (AASM) recommend?  Unattended portable monitoring (home monitoring) for the diagnosis of obstructive sleep apnea may be used as an alternative to polysomnography for the diagnosis of OSA in patients with a high probability of moderate to severe OSA.  But it is not appropriate for the diagnosis of OSA in patients with significant medical conditions that may degrade the accuracy of the test or for patients suspected of having multiple sleep disorders.

Remote monitoring is not a new concept and with a permanent CPT code, home sleep studies are here to stay.  The lower cost of the studies allows the technology to fit in with the drive of healthcare to cut expenses.  I have also seen a growing trend of portable sleep technology in the MD Buyline database, so it appears hospitals are also starting to extend their reach to the home market.

James Laskaris, EE, BME
James Laskaris, EE, BME, Clinical Analyst — Mr. James Laskaris is a senior emerging technology analyst at MD Buyline and has been with the company since 1994. With over 30 years of experience in the healthcare field, Mr. Laskaris is the primary analyst of high-end OR technology. He also covers issues related to the legislative and reimbursement effect on healthcare and authors a bimonthly “Issues that Matter” publication. Mr. Laskaris received his biomedical engineering degree from Southern Illinois University. His work has been published in hfm Magazine, Radiology Manager and Healthcare Purchasing News.