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Sleep Study

Ramona Posted Fri 16th of September, 2011 20:43:19 PM

When billing cpt codes '95805, 95807, 95811' for professional component done as out patient what place of service is used. I have received some confusing information from different Insurance companies

SuperCoder Answered Sun 18th of September, 2011 02:04:36 AM

When submitting bills, providers should be aware of two designations: place of service indicators and modifiers. Place of service indicators typically used for sleep studies include the following: OH = outpatient hospital, and O = office.

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The definitions of these settings are given in the Centers for Medicare and Medicaid Services (CMS) database of place of service codes and descriptions. According to the CMS, "These codes should be used on professional claims to specify the entity where services were rendered. Check with individual payers for reimbursement policies regarding these codes."

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As per American Medical Association, modifiers include the following:
(1) physician services: -26 to designate that the charge is only for the interpretation of the study;
(2) technical services: -TC to designate that the charge is for the study without the professional interpretation charge; and
(3) can be billed globally to indicate that the charge is for both the professional and technical charge

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