Sleep medicine billing most billers never learned

Prior authorization comes first. Most plans gate in-lab polysomnography (95810) and titration studies; many require a home sleep test before an in-lab study is approved. The standard: the payer's diagnostic sequence confirmed per plan before anything is scheduled — a night in the lab without authorization is usually free work.

Home sleep tests have their own rules. Home-test codes and coverage differ by payer — Medicare and commercial plans don't gate them the same way, so the biller must confirm the current requirement per plan rather than assume.

Billing depends on the arrangement. A physician reading studies for an outside lab bills the professional component with modifier 26; a practice-owned lab may bill global. When both parties bill global — or overlapping components — payers see duplicates and deny both. The arrangement must be papered, with standing billing rules per site.

CPAP compliance is a billing issue. Therapy coverage and resupply depend on documented usage compliance and follow-up windows. Miss the documentation and downstream claims fail quietly, for months. Someone has to own that calendar — ask any prospective biller who would.