In-lab polysomnography
A study counts as PSG only when sleep is staged and a qualified technologist attends. Under Medicare contractor guidance, a split-night study bills 95811 alone, and a recording under six hours takes modifier 52.
Sleep studies bill on channels, hours, and accreditation
An in-lab polysomnogram, a home sleep apnea test, and a CPAP follow-up each have their own coding and documentation rules. Payers also check whether the lab, the technologist, and the reading physician meet accreditation and credentialing requirements. Most rework starts with one of those details.
Book a demoWhere sleep claims get rejected
Sleep practices and testing centers share three recurring trouble spots.
Home sleep apnea testing
Home tests are coded by monitor type and channel count. Some insurers accept G0398, G0399, and G0400, while others want CPT 95800, 95801, or 95806, so code choice depends on the payer.
CPAP and the follow-up visit
The DME supplier bills the CPAP, but coverage rests on your records: an in-person evaluation before the test and a qualifying AHI or RDI. To keep coverage past 12 weeks, a reassessment has to document adherence and symptom improvement.
Separate the test, the read, and the device
A sleep study can involve a testing facility, a reading physician, and an equipment supplier. Each bills its own part.
What the practice keeps
Your sleep physicians document the evaluation, interpret studies, and record adherence reviews, then approve codes before submission. Technologist logs and accreditation records stay with the lab.
What Taiga would take on
Should the fit check out, Taiga would draft codes from study reports and visit notes, verify eligibility and each payer's code preferences, submit clean claims, and work denials and appeals.
Where a decision is needed
If your lab is enrolled as an independent diagnostic testing facility, its claims and the physician's read may bill differently. Decide which entity's claims are in scope.
Questions for a sleep medicine fit call
Bring de-identified study reports and a short list of recent rejections. No patient identifiers are needed to book.
How is your lab set up?
Say whether studies run in a hospital, a practice-owned lab, or an IDTF, and which accreditation the lab holds.
What is your home testing mix?
Share how many home tests you run versus in-lab studies, and which payers want G codes versus CPT codes.
How do CPAP records reach the supplier?
Explain who sends evaluation notes, test results, and adherence reassessments to equipment suppliers.
For sleep practices and testing centers
Useful when a sleep practice or lab bills its own claims and keeps losing time to technical rejections and supplier paperwork. No change of EHR is part of the conversation.
Device claims belong to the supplier
This page covers testing and professional claims. CPAP machines and supplies are billed by the DME supplier, and lung disease care outside sleep is covered on the pulmonology page.
Questions about sleep medicine billing
Does Taiga support sleep medicine practices?
Sleep medicine is not one of the specialties Taiga names publicly. A short call about your lab and clinic setup will settle whether it fits.
How do we bill a split-night study?
Under Medicare contractor guidance, a split-night study is billed with 95811 alone, because 95811 already includes 95810.
Should home sleep tests use G codes or CPT codes?
It depends on the payer. Some accept G0398 through G0400 and others want CPT 95800, 95801, or 95806, so confirm before the study is billed.
What does Medicare need to keep paying for CPAP?
Continued coverage after the first 12 weeks depends on a practitioner reassessment that documents adherence and improvement in sleep apnea symptoms.
Map your sleep testing claims
Bring your lab setup, home testing volume, and supplier workflow. Taiga will show which claims it would handle and which stay put.
System guides show possible billing handoffs, not proven specialty compatibility.