Overview
In this article will find guidance on submitting authorizations for facility-based sleep studies.
Submitting an authorization for facility based sleep study tests
When submitting authorizations for facility based sleep study tests, it is important that you request the most appropriate test for your patient. In most cases, you will request one of the following common sleep study tests:
[95810] Diagnostic Polysomnogram (PSG): Test to determine whether a patient has sleep apnea.
[95811] Titration Polysomnogram (PSG): Test to assess if CPAP or BiPAP can effectively treat sleep apnea.
[95811] Split night Study: Used for combination of both the Diagnostic PSG (95810) and Titration PSG (95811) tests into one night of study.
When submitting an authorization for one of these tests, you should only request approval for one of these codes. It is not medically necessary or appropriate to submit a request that includes both of these codes.
If your patient requires both a Diagnostic PSG (95810) and a Titration PSG (95811), you will use only the code 95811 to request a Split Night Study, meaning both tests may occur on the same night.
Because code 95811 is used for both a Titration PSG Test and a Split Night Study Test, when you enter this code into the Cohere portal you will be prompted to specify which of these tests you are requesting. As a reminder, you should only request approval for one of these tests. See screenshot below.
For further clarity, please refer to the diagram below for guidance on when to use each code.
Code | Test Name | Test Description | When do I use this code? |
95810 | Diagnostic PSG | Test to determine whether a patient has sleep apnea. | When a patient needs only this test, submit only this one code in your request. |
95811 | Titration PSG | Test to assess if CPAP or BiPAP can effectively treat sleep apnea. | When a patient needs only this test, submit only this one code in your request. You will be prompted to select PAP Titration test in the portal. (see screenshot above) |
95811 | Split Night Study | Combination of both the Diagnostic (95810) and Titration (95811) PSG tests into one night of study | When a patient needs BOTH of the above tests to happen in one night use ONLY this one code in your request. You will be prompted to select Split-Night Polysomnogram in the portal. (see screenshot above) |