Sleep Medicine Billing Services

Medicare covers diagnostic polysomnography (95810) and titration (95811) with prior authorization required through most Medicare Advantage plans. Medicare requires that home sleep testing be attempted first for uncomplicated obstructive sleep apnea in patients without significant comorbidities. CMS pays approximately $500 for diagnostic PSG and $650 for titration PSG under the Physician Fee Schedule (professional component). Commercial payers almost universally require prior authorization for in-lab polysomnography. UnitedHealthcare mandates HST first for patients with a high pretest probability of moderate-to-severe OSA. Anthem BCBS requires the Epworth Sleepiness Scale score and BMI in the authorization request. Aetna limits in-lab PSG to patients with cardiopulmonary comorbidities, neuromuscular disease, or failed HST. Cigna uses eviCore for sleep study prior authorization with clinical criteria that require documented symptoms plus either a screening questionnaire score or comorbidity. We submit all authorization requests with complete clinical documentation to minimize delays.