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Good morning all. I'm wondering about Home Sleep Testing and reimbursement.
First, when I send a patient to a sleep doc for their consultation/evaluation visit, I send the HST if I did one for screening. I am now seeing those sleep docs use that HST for the actual diagnosis. My question, can we send that HST to the insurance company and receive reimbursement? If yes, what code?
Second, when I do an HST for titration purposes, and it is done 90 days or more after delivery of the appliance, can i send to insurance for reimbursement? Code?
Thanks...I know there is much going on at sleep centers these days and HST/Out-Of-Center-Testing is being used by the sleep docs for diagnostic purposes. Anyone else seeing this too?
Steve green
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Hi Dr Green!
Yes, you can send in for reimbursement for HST! (check the insurer's medical policy to be sure they allow HST, and what the coverage criteria for an HST is!)
The code you will use depends on the HST unit you are using (there are 3 main codes). Which unit(s) do you use?
As for the titration, you would be using the same code to bill the HST, however, it will depend on the patient's policy and the insurer whether they will cover services within 90days of seating the appliance (HST included in that!). Some policies currently allow you to bill out all follow up, some policies will included services within 90days of seating the appliance in the reimbursement for E0486.
And yes - we have been seeing the same thing! There are several insurers that are changing/updating their policies to require HST as first line instead of in lab PSG for a generally healthy patient with signs & symptoms of OSA! So, the tables have turned a bit, and now instead of having to supply quite a bit of documentation for pre-auth of HST, you have to do that for a patient to qualify for a PSG with many insurers, and they are allowing HST's without pre-auth!
Hope this helps - please let us know if you have any further questions!
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