There are four levels of sleep tests based on the number of physiologic parameters measured:
- Type 1 sleep studies: Performed in a sleep laboratory, record at least 12 physiologic parameters
- Type 2 studies: Home-based, record 7 or more physiologic parameters
- Type 3 studies: Home-based, record 4-7 physiologic parameters
- Type 4 studies: Home-based, measure 3 or fewer physiologic parameters
In-home sleep tests (HSTs) are performed:
- With an oral appliance to monitor the patient's response
- At a reduced out-of-pocket liability
In patients with a high pre-test probability for moderate to severe OSA, research shows that HSTs are non-inferior to in-center studies. In fact, there was no difference in post test sleepiness scores, sleep quality, quality of life, blood pressure and CPAP adherence.
Obstructive Sleep Apnea - 91333
Sleep studies coverage
Home-based studies that measure 3 or fewer physiologic parameters are not covered.
In-center sleep studies may be used to diagnose sleep disorders other than obstructive sleep apnea.
Sleep studies authorizations
Not required for in-home sleep studies/home sleep tests (HSTs). If the result of an HST is negative in a patient suspected of having OSA, the patient can be referred to a certified sleep specialist for evaluation. This evaluation does not require prior authorization.
Required for in-center sleep studies. Authorizations cover a split-night study that is completed during the initial night of testing.
In-home sleep test billing
Only when used to diagnose obstructive sleep apnea (OSA) and results are interpreted by an American Board of Sleep Medicine (ABSM) certified sleep specialist.
For general screening of asymptomatic patients.
In-center sleep study billing
- When used to diagnose OSA and sleep disorders other than OSA
- When ordered and interpreted by a certified sleep specialist
- If the study results include a recommendation for the appropriate progressive airway pressure (PAP) dose following an APAP trial by the sleep specialist who interprets the study results