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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.67 Sleep Studies : 9.2.67.3 Polysomnography

9.2.67.3
Polysomnography (procedure codes 95782, 95783, 95808, 95810, and 95811) is a benefit of Texas Medicaid.
Polysomnography is distinguished from sleep studies by the inclusion of sleep staging that includes a 1‑to 4- lead electroencephalogram (EEG), electro-oculogram (EOG), and a limb or submental electromyogram (EMG).
Additional parameters of sleep that are evaluated in polysomnography include, but are not limited to, the following:
For a sleep study to be reported as a polysomnography, sleep must be recorded and staged. Use the following procedure codes to bill for polysomnography studies: 95782, 95783, 95808, 95810, and 95811.
Polysomnography (procedure codes 95782, 95783, 95808, 95810, and 95811) is limited to one per day and two per rolling year by any provider and is allowed for the following diagnosis codes:
 
Claims denied for more than two times per year may be appealed with documentation of medical necessity.
Documentation of the polysomnography testing must be maintained in the client’s medical record at the sleep facility and include approximately 1,000 pages or the electronically-stored equivalent of data during a single nighttime recording. Each record must be for sleep-wake states and stages, cardiac arrhythmias, respiratory events, motor activity, oxygen desaturations, and behavioral observations.
Documentation must also include the technologist’s analysis and report, the patient’s subjective report, and the influence of intervention applied during the night.
Interpretation and treatment recommendations must be completed by a sleep specialist. The physician’s professional interpretation and report must include inspection of the entire recording, examination of the technologist’s analysis and observations, and integration of the information gathered from all physiological systems. Documentation of the interpretation must be maintained in the sleep facility and by the interpreting physician.

Texas Medicaid & Healthcare Partnership
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