At Singular Sleep, many of our patients have high-deductible health plans with or without health care spending accounts (HSA) or flexible spending accounts (FSA). These patients often find that they can save a lot of money and time by using us to get a sleep apnea test, consult with our sleep doctor, and purchase CPAP and BPAP products. But folks often want to submit invoices to their insurance companies for reimbursement purposes or to count towards their deductibles. Here is some helpful information that can make it easier for you to file claims with your health care insurance company to get reimbursed for your sleep disorder. Below are the most common codes that we use:
What is the ICD-10 code for sleep apnea?
The tenth edition of the International Classification of Diseases (ICD-10) took effect October 1, 2015, replacing ICD-9. As the name says, these codes are used to classify different medical disorders.
Obstructive Sleep Apnea, Adult
- ICD-10 CM code: G47.33
- ICD-9 CM code: 327.23
Sleep Apnea, Unspecified
- ICD-10 CM code: G47.30
- ICD-9 CM code: 327.20
Primary Central Sleep Apnea
- ICD-10 CM code: G47.31
- ICD-9 CM code: 327.21
Sleep related hypoventilation (hypoxemia) in conditions classifiable elsewhere.
- ICD-10: G47.36
- ICD-9: 327.26
What are the CPT codes for a home sleep apnea test and my online sleep doctor consultations?
Current Procedural Terminology (CPT ) codes are used for health care provider services and medical procedures.
For the home sleep testing units that we use, the most appropriate CPT code is 95806.
Note: some insurers require - or also accept- the "G code" G0399 for a home sleep study. G codes are from the HCPCS (see system below).
Evaluation and management codes - also known as E&M or E/M codes
E&M codes are a subset of CPT codes used for medical evaluations by health care providers. The most appropriate codes to use for your sleep doctor consult are:
Office or other outpatient visits: 99220 - 99215; complexity of the medical encounter will determine the exact code to use.
What are the HCPCS codes for my CPAP machine and mask?
Healthcare Common Procedure Coding System (HCPCS) are used for medical devices such as durable medical equipment, including CPAP, BPAP, CPAP masks, and oxygen therapy. Here are the most common sleep-related HCPCS codes:
E0601: CPAP machine, (often incorrectly spelled "CPAC," "C-PAC" or "CPAK."). This code is used for both fixed-pressure and auto-titrating CPAP (APAP) machines.
E0470: BPAP machine, aka "BiPAP," bilevel. This code is used for both fixed-pressure and auto-titrating BPAP (auto-BPAP) machines.
Masks and Replacement Mask Cushions
A7030: full face mask (covers both the nose and mouth) for use with PAP machine
A7021: replacement cushion for full face mask (A7030)
A7034: nasal interface (covers nose (nasal mask) or fits under nose (nasal pillows)) for use with PAP machine
A7032: replacement cushion for nasal mask
A7033: replacement pillows for nasal pillows mask
A7027: combination nasal and oral mask for use with PAP machine, e.g. the hybrid mask.
A7028: replacement oral cushion for combination nasal and oral mask (A7027)
A7029: replacement nasal pillows for combination nasal and oral mask (A7027)
A7036: chin strap for use with PAP mask
PAP Machine Replacement Parts
A7037: tubing (hosing) for PAP machine
A4604: heated tubing (heated hosing) for PAP machine, e.g. Hybernite tubing
A7038: disposable air filter for PAP machine
A7039: reusable (non-disposable) air filter for PAP machine
A7046: humidifier for PAP machine
A7047: water chamber for humidifier
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