Pennsylvania Sleep Society

An online forum for the Pennsylvania Sleep Society


    Are HST's being reimbursed higher than lab based PSG's here in NE PA for 2011?

    Share

    JamieB

    Posts : 5
    Join date : 2010-12-01
    Location : Lebanon, PA

    Are HST's being reimbursed higher than lab based PSG's here in NE PA for 2011?

    Post  JamieB on Wed Dec 01, 2010 9:27 am

    According to my Pennsylvania Locality 99 issue of the January 2011 Medicare Physician's Fee Schedule it would appear that unattended studies are being reimbursed at a higher rate than lab-based PSG's. Can anyone help explain this?

    According to Sleep Review Magazine there are 2 new codes for 2011:

    CPT Code 95800 is "sleep study unattended, simultaneous recording, heart rate, oxygen saturation, respiratory analysis (eg by airflow or peripheral arterial tone), and sleep time." while

    CPT Code 95801 is similar, but without sleep time: "sleep study unattended, minimum of heart rate, oxygen saturation and respiratory analysis (eg by airflow or peripheral arterial tone)."

    When looking at my 2011 Fee Schedule procedure code G0400 (Type IV HST) has a PAR FEE of $145.73. Procedure code 95810 (lab-based sleep study) has a PAR FEE of $504.27. Yet, the new unattended sleep study 95800 has a PAR FEE of $945.05 and the 95801 has a PAR FEE of $1,599.28.

    This doesn't make any sense. I must be misinterpreting this information somehow.
    Please help.

    JamieB

    Posts : 5
    Join date : 2010-12-01
    Location : Lebanon, PA

    Got our answer!

    Post  JamieB on Fri Dec 03, 2010 3:08 pm

    Many thanks to my friend Mike M. from the PA Sleep Society for answering this question. I will re-post here what he found in case anyone else was wondering the same question. This came from the AASM website:

    Question: On the Medicare fee schedule for (state removed), the reimbursement rate for 95800 is $1000, and the reimbursement for 95801 is $1700. Is this correct? It makes no sense, as these are unattended studies and pay several times more than 95810.
    Category: 2011 Final Rule

    Answer: It is correct that in the display copy of the Physician Fee Schedule, the total RVUs listed for both codes 95800 and 95801 is higher than the total RVUs for 95810. The American Medical Association has contacted the AASM on behalf of CMS with a request for additional practice expense information for codes 95800 and 95801, which we have provided. CMS may be looking for this additional information in order to correct a potential error in their calculations for those codes.

    If corrections are made to the RVUs for codes 95800 and 95801, the corrected information may be found in the November 29 publication of the Physician Fee Schedule in the Final Register. Alternatively, corrections may be addressed in a separate corrections document published by CMS at a later date. However, at this time, we are not certain if or when corrections will be made to the two codes.


    Question: Are G codes now replaced by 95800 and 95801? If not, under what conditions are the codes suppose to be used? And what happens to 95806 that was initially meant for non-attended studies?
    Category: 2011 Final Rule

    Answer: No, codes 95800 and 95801 replaced the T codes (0203T and 0204T). The G codes are still listed on the Medicare fee schedule for 2011 and are valid codes. Descriptors for these codes are found in the Healthcare Common Procedure Coding System (HCPCS), Medicare’s National Level II Codes and are maintained by the federal government.

    G0398 Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG/heart rate, airflow, respiratory effort and oxygen saturation

    G0399 Home sleep study test (HST) with type II portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation

    G0400 Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels

    JamieB

    Posts : 5
    Join date : 2010-12-01
    Location : Lebanon, PA

    HST Reimbursement

    Post  JamieB on Tue Jan 04, 2011 3:22 pm

    Was contacted yesterday by Highmark Medicare Services. The new reimbursement values have been posted. Here is a link:

    https://www.highmarkmedicareservices.com/partb/reimbursement/feedb-2011.html

    Sponsored content

    Re: Are HST's being reimbursed higher than lab based PSG's here in NE PA for 2011?

    Post  Sponsored content


      Current date/time is Sun Nov 19, 2017 3:46 pm