In response to recent policy and billing questions, NC Medicaid would like to clarify that respiratory supplies needed to conduct a Home Sleep Tests (HST) or Unattended Sleep Study are not covered separately.
Effective Oct. 1, 2020, the following update was made to Clinical Coverage Policy 5A-2, Respiratory Equipment and Supplies in subsection 5.3.2:
The medical necessity criteria for respiratory assist devices to manage central sleep apnea and obstructive sleep apnea were updated to indicate that qualifying polysomnograms must be provided according to the requirements listed in Clinical Coverage Policy 1A-20, Sleep Studies and Polysomnography Services.
Specifically, the requirement for a facility-based polysomnography by qualified personnel was removed, as Clinical Coverage Policy 1A-20, Sleep Studies and Polysomnography Services, allows for home sleep studies of Obstructive Sleep Apnea in subsection 3.2.1, criterion b. “Home Sleep Test (HST) or Unattended Sleep Studies”.
Please also note that Clinical Coverage Policy 1A-20, Sleep Studies and Polysomnography Services, was updated on May 1, 2020, to include 95800 Sleep study, unattended, simultaneous recording, heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time.
The device used for an unattended or home sleep test is not coded separately. The physician dispatches the device for the patient to take home and the patient returns or ships back the device to the physician’s office.
Contact
NC Medicaid Contact Center, 888-245-0179
NC Medicaid Managed Care health plans