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The CPT® Code 95801 refers to an unattended sleep study that is conducted using a portable sleep study system, typically in the patient's home or another ambulatory setting. This type of sleep study is increasingly utilized due to the growing backlog at traditional sleep study centers and the significant number of patients who reside far from these facilities. Unlike full-night polysomnography, which is performed in a sleep center and records a comprehensive range of parameters, the unattended sleep study captured by this code records a minimum of three key physiological parameters: heart rate, oxygen saturation, and respiratory analysis. The respiratory analysis can be conducted through two primary methods: airflow measurement or peripheral arterial tone (PAT). Airflow measurement can be achieved using either a thermal sensor placed on the upper lip or a mask that covers the nose and mouth, both of which evaluate the airflow during sleep. This airflow data is then combined with heart rate and pulse oximetry readings to assess any respiratory disturbances that may occur. On the other hand, PAT measures changes in arterial pulsatile volume in the finger, which reflects the activity of the sympathetic nervous system. This method indirectly detects apnea events by identifying surges in sympathetic activation that occur at the end of an apnea episode. The data collected from PAT, along with heart rate and pulse oximetry, is analyzed by the portable device to calculate the PAT respiratory disturbance index (RDI). The setup of the portable device involves programming it to record the necessary data as the patient sleeps. If airflow is being measured, a snug-fitting mask is placed over the patient's mouth and nose, or a thermal sensor is positioned on the upper lip. For PAT measurement, a device that includes the PAT sensor, heart rate monitor, and oximetry device is attached to the patient's finger. The system then records the relevant data throughout the patient's sleep period. It is important to note that if the sleep time is also measured, the appropriate code to use is 95800, whereas 95801 is used when sleep time is not measured.
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The unattended sleep study represented by CPT® Code 95801 is indicated for patients who require assessment of sleep-related disorders, particularly when traditional sleep study facilities are not accessible. The following conditions may warrant the use of this procedure:
The procedure for conducting an unattended sleep study using CPT® Code 95801 involves several key steps to ensure accurate data collection and analysis. The following outlines the procedural steps:
Post-procedure care for patients who have undergone an unattended sleep study using CPT® Code 95801 typically involves reviewing the recorded data with a healthcare provider. The provider will discuss the findings with the patient, which may include recommendations for further evaluation or treatment based on the results. Patients may be advised to maintain a sleep diary or follow specific sleep hygiene practices to improve their sleep quality. Additionally, if significant sleep disturbances are identified, the provider may recommend further testing or interventions, such as continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea.
| Short Descr | SLP STDY UNATND W/ANAL | Medium Descr | SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL | Long Descr | Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone) | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | STV-Packaged Codes | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | T2D - Other tests - other | MUE | 1 | CCS Clinical Classification | 227 - Other diagnostic procedures (interview, evaluation, consultation) |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GZ | Item or service expected to be denied as not reasonable and necessary | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles |
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| 2011-01-01 | Added | Added |
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