Updates made to the Sleep Studies Medicaid Policy will become effective for date of service on or after March 1, 2025.
Benefit information will be updated in the Texas Medicaid Provider Procedures Manual (TMPPM), Medical and Nursing Specialists, Physicians, and Physician Assistants handbook.
Key Details:
Effective for dates of service on or after March 1, 2025
Updates to policy include:
- Expansion of the Sleep Studies Medicaid Policy to include a new home sleep study test. Procedure code 95800 will become a benefit of Texas Medicaid for clients who are 18 years of age or older effective March 1, 2025.
- Procedure code 95800 describes a device that measures three or more channels, including pulse oximetry, actigraphy, and peripheral arterial tone (PAT).
- Clarified diagnosis restrictions and prior authorization requirements.
- Clarified reimbursement/billing guidelines.
Additional Information:
Limitation Updates
Procedure code 95800 is limited to one study per day, any provider and two tests per rolling year, any provider:
Provider Type Updates
Procedure code 95800 may be reimbursed to the following provider types and places of service:
Resources:
A copy of the final draft of the Sleep Studies policy can be found in the Texas Medicaid Provider Procedures Manual (TMPPM), Medical and Nursing Specialists, Physicians, and Physician Assistants handbook Section 9.2.71.
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6294. You can also contact your Provider Relations Representative directly.
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