News
Prior Authorization and Sleep Studies
Date: 06/15/16
Ambetter from Arkansas Health & Wellness understands the importance of easy access to care. So, we are committed to ensuring our prior authorization requirements continue to be appropriate and efficient.
Effective September 15, 2016, home-based sleep studies will no longer require prior authorization. The codes affected by this change include:
| Code | Description |
|---|---|
| 95800 | Sleep study, unattended, simultaneous recording; 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, and respiratory analysis (e.g., 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 |
| G0398 | Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation |
| G0399 | 9 Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen |
| G0400 | Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels |
To avoid claim denials, please refer your Ambetter patients to a participating provider to read the results of home-based sleep studies.
If you have any questions, please reach out to Provider Services at 1-877-617-0390. And, thank you for partnering with Ambetter from Arkansas Health & Wellness.