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rhayes
#1 Posted : Tuesday, May 7, 2013 1:11:55 PM(UTC)
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rhayes

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I have a sleep lab concidering having the dentist take over billing out for the home sleep test. If I were to do that, how would it be billed to medical?
courtneydsnow
#2 Posted : Tuesday, May 7, 2013 1:34:21 PM(UTC)
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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!
rhayes
#3 Posted : Tuesday, May 7, 2013 2:52:26 PM(UTC)
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I would be using the machine that the sleep lab is currently using, I'm not sure what kind it is and they did not say anything about me buying it. I will find out. Another question I have, if I presceen my pts for snoring using the WatchPat, what should I charge my pt?
courtneydsnow
#4 Posted : Tuesday, May 7, 2013 6:46:51 PM(UTC)
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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
rhayes
#5 Posted : Wednesday, May 8, 2013 11:29:36 AM(UTC)
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rhayes

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Another Question, if I charge $250 for the presceen Watchpat would we bill that to insurance, or is that out of pocket to the pt?
courtneydsnow
#6 Posted : Monday, May 13, 2013 10:16:57 AM(UTC)
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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!
lexingtonpark
#7 Posted : Sunday, October 27, 2013 9:24:13 AM(UTC)
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lexingtonpark

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What code would you use for the WatchPat study?
If we charge the insurance for the study - will they still be eligible to have a study done at a sleep lab?
courtneydsnow
#8 Posted : Monday, October 28, 2013 11:06:45 AM(UTC)
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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!
Guest
#9 Posted : Tuesday, February 11, 2014 8:32:35 PM(UTC)
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great questions and answers; do you know if the insurance will pay for HST done for the titration of the oral appliance?
courtneydsnow
#10 Posted : Wednesday, February 12, 2014 9:00:08 AM(UTC)
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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
kanehldental
#11 Posted : Thursday, April 17, 2014 10:08:14 AM(UTC)
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kanehldental

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What is the code for the Embletta Gold? 01 or 06?
kanehldental
#12 Posted : Thursday, April 17, 2014 10:09:50 AM(UTC)
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kanehldental

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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.
courtneydsnow
#13 Posted : Thursday, April 17, 2014 2:03:30 PM(UTC)
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courtneydsnow

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Hi kanehldental!

Great questions.

Q1 - What is the code for the Embletta Gold? 01 or 06?


There are three CPT codes commonly used to code for home sleep testing -

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

95801 - sleep study, unattended, simultaneous recording; minimum of, heart rate, oxygen saturation,
respiratory analysis (e.g. by airflow or peripheral arterial tone)

95806 - sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg. Thoracoabdominal movement)

Below is a graph provided by Embla on their website of the channels recorded by the Embletta Gold:



Q2 - 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.

Great question - the answer to this one is that is will depend on your state board's position on whether or not it is within a DDS/DMD's scope of practice or not to administer a home sleep test, and whether or not the patient's insurance company requires than an MD/DO be the rendering provider for sleep testing or not.

Hope this helps!

Edited by user Thursday, April 17, 2014 2:05:04 PM(UTC)  | Reason: Not specified

courtneydsnow attached the following image(s):
embletta gold.JPG
SBrushDDS
#14 Posted : Monday, June 29, 2015 9:08:29 AM(UTC)
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SBrushDDS

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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

courtneydsnow
#15 Posted : Monday, June 29, 2015 12:28:33 PM(UTC)
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Hi SbrushDDS!

Great questions:

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

95810 stands for: (Polysomnography; sleep staging with four or more additional parameters of sleep, attended by a technologist)

So this would only be used for an in-lab attended study.

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

So for an HST, as long as the unit you are using meets the description of 95800 above, that would be the most appropriate code. Other HST codes are 95801 and 95806.


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


Usually yes as long as the study is being interpreted by a sleep physician on both instances.


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


The Medicare fee schedule is a publicly accessible fee schedule, so that is usually a good resource. I would be happy to send you the information for your area if you would like! (i believe you are in Maryland?)


And finally, yes you can receive e-mail notification :) You can either click the checkbox when you are making a post, found right above the "post" button that says "watch this topic and receive notification of activity via e-mail". Or, you can watch entire threads by choosing the "watch forum" link in the lower right hand corner of any of the threads in the DW forums.

Hope this helps, please feel free to contact us with any further questions!
Guest
#16 Posted : Monday, June 29, 2015 2:07:11 PM(UTC)
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Thank
you and yes please send me the fee information for Maryland!

Robin
courtneydsnow
#17 Posted : Monday, June 29, 2015 3:51:19 PM(UTC)
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courtneydsnow

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Hi Robin!

No problem :) Here are the current day amounts for CPT 95800 for Medicare Part B for maryland (Novitas, Jurisdiction L) for the baltimore & surrounding counties locality:

Participating: 196.23
Non-participating: 186.42
Limiting charge: 214.38

Of course keep in mind, Medicare tends to be on the lower average fee range.....

Hope this helps, and please let us know if you have any further questions!
kasper2
#18 Posted : Saturday, September 9, 2017 12:36:19 PM(UTC)
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kasper2

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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.
Guest
#19 Posted : Monday, January 22, 2018 6:28:39 PM(UTC)
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If a patient is not utilizing any insurance and tested negative for sleep apnea but still wants a sleep appliance are we able to make her one? if not can we make her a temporary sleep appliance?
courtneydsnow
#20 Posted : Tuesday, January 23, 2018 8:42:38 AM(UTC)
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courtneydsnow

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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).
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