Hi rhayes!

a few questions:

1) will you be purchasing the HST unit and dispensing it from your office? and,
2) What type of HST unit will be used? (there are a few different codes for HST unit depending on that "level" of HST the unit is.

Thanks!

hi rhayes!!

Ok great, the codes available, depending on what all the HST unit that will be used records, are the following: 95806, 95800, & 95801.

95800 Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time

95801 Sleep study, unattended, minimum of heart rate, oxygen saturation and respiratory analysis
(eg, 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


Now, as far as the using a watchpat to pre-screen.....we usually see fees between approx $150-600 to the patient, depending on the unit. You will want to keep your disposable per HST test cost in mind - so probably about $200-$250 range (depending on the unit).

Hope this helps, please feel free to contact us with further questions!

Thanks

Great question! As long as the patient is exhibiting signs & symptoms of OSA (snoring, excessive daytime sleepiness, gasping at night, hypertension, etc) and those signs & symptoms meet the insurers criteria to meet medical necessity for the sleep study, you can bill the HST to the medical insurance!

Let us know if you have any further questions!

hi lexingtonpark!

Great question.....

The most appropriate CPT code for the watchpat HST is:

95800: sleep study, unattended, simultaneous recording: heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone) and sleep time.

The patient's policy will determine whether an in-lab PSG & HST are covered or not covered, and the time period for each as well (you can search the insurer's medical policy for sleep testing on their website!)

Hope this helps, let us know if you have any further questions!

Great question! Many insurers will provide coverage for follow up studies used to test the efficacy of an oral appliance. The insurers medical policy for oral appliances and/or sleep testing will clarify that particular insurers guidelines (sometimes found under "medical management of OSA" or "diagnosis of sleep disorders/sleep apnea", etc etc).

For example, in BCBS of TX's medical policy "Diagnosis and Medical Management of Sleep Related Breathing Disorders" - it states:

REPEAT UNSUPERVISED STUDIES

Repeated unattended (unsupervised) home sleep studies with a minimum of four recording channels (including oxygen saturation, respiratory movement, airflow, and EKG/heart rate) may be considered medically necessary in adult patients under the following circumstances:

To assess efficacy of surgery or oral appliances/devices; OR

To re-evaluate the diagnosis of OSA and need for continued CPAP, e.g., if there is a significant change in weight or change in symptoms suggesting that CPAP should be retitrated or possibly discontinued.

Here is a link to the full policy: http://medicalpolicy.hcsc.net/medicalpolicy/home?ctype=POLICY&cat=Medicine&path=/templatedata/medpolicies/POLICY/data/MEDICINE/MED205.001_2013-10-01#hlink

You can find these medical policies right on the insurers website in many cases, on the providers page of their site (many time listed under "Medical Policies", "Practice Resources", "Policies, Procedures & Guidelines", "Clinical Policy Bulletins", "Local Coverage Determinations", etc etc.)

Hope this helps! Please feel free to contact us with any further questions

Second question. As a dental office can we charge insurance for the first test (as in not formerly diagnosed with OSA)? Previously the answer was no (I'm not sure why), but the above question/answer makes me think we can.

I know this may be redundant but I found the responses below unclear regarding the billing insurance for a post oral appliance delivery titration using a HST (in particular ours is a WATCHPat. We do a titration 12-months post delivery.

I have a two part question:

1) I see that the CPT code for titration may be 95810? Or as it seems above you should use 95800?

2) Would the fee for a titration be the same as a study?

3) Where can one go to find the average fees for your geographic area?

Thank you for your response.

PS as a new poster - do I receive notifications of a response or do I just have to keep checking back on this particular forum?

Robin Coblyn

Thank
you and yes please send me the fee information for Maryland!

Robin

There is an excellent mean which simply rescues from snoring and allows well to sleep, zyppah http://aboutzyppah.com/ I a long ago use them and he well helps to avoid noise and quietly to sleep.

Hi Guest!

Yes, as long as the physician is not recommending any additional testing, an appliance for primary snoring can certainly be fabricated. However, most medical plans do not offer coverage for custom made appliances (E0486) when the diagnosis is snoring alone or upper airway resistance syndrome (which doens't sounds like an issue in this case).