Monday, November 9, 2015

Sleep Study Authorization Program Change CPT code 95782, 95783, 95800, g0398, G0399


Important Change:
The Sleep Study Authorization program implementation date , previously scheduled for April 1, 2015 and earlier, has been changed to May 1, 2015.Please disregard all previous communications indicating earlier implementation dates.

Effective May1, 2015, Florida Blue and Florida Blue HMO (Health Options, Inc.)will implement the mandatory preservice review/prior authorization program for sleep and titration studies. The Sleep Study Authorization program applies to the following networks:
NetworkBlue (BlueOptionsSM), Health Options, Inc. (BlueCare®HMO) and Blue Select.

Florida Blue and Florida Blue HMO (Health Options, Inc.) have contracted with Sleep Management Solutions to manage the Sleep Study Authorization Program. The program is designed to maximize patient care in the most appropriate and affordable manner based on clinically accepted standards.

Providers Participating in the Sleep Study Authorization Program

Effective May1, 2015, providers who are subject to the Sleep Study Authorization Program must submit all sleep study procedures (as set forth on Appendix A) to Sleep Management Solutions for preservice review/prior authorization. Failure to seek a preservice review/authorization will result in a denial of the claim and the provider will not be entitled to compensation from Florida Blue or Florida Blue HMO or from the member for any such services rendered. The authorization requirement is applicable to all Florida Blue and Florida Blue HMO (Health Options, Inc.) products in which contracted providers participate
. This program will not apply to members who are covered through self-insured administrative services only (ASO) plans nor will it apply to any members of other Blue
Plans who may access the above networks through BlueCard®.

How to Obtain Prior Authorization through Sleep Management Solutions 
• Access the Sleep Management Solutions website at www.sleepsms.com.
• You may also access the Sleep Management Solutions website through a link on Availity®1at availity.com ; select Payer Resources and then Florida Blue.

Important:
• Effective May 1, 2015, you must refer to the Prior Authorization Program section of the Florida Blue Manual for Physicians and Providers for a list of sleep study procedures that require prior authorization. You can access the provider manual at providermanual.bcbsfl.com on our home page at www.floridablue.com/authorization.
• Appendix A on the following page also provides a list procedures included in the program.
If you have any questions or require any additional information about this information, please call the Provider Contact Center at (800) 727-2227

Appendix A
Sleep Study Procedures (Procedure list is subject to change.)

95782 - Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist

95783 - Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist

95800 - Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis(e.g., by air flow 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)

95805 - Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness

95806 - Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, unattended by a technologist

95807 - Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist

95808 - Polysomnography; any age, sleep staging with 1 –3 additional parameters of sleep, attended by a technologist

95810 - Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist

95811 - Polysomnography; age 6 or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by 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 - 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

Note: The list above is not all-inclusive.

No comments:

Post a Comment

Popular Posts