The following Category I Code has been approved for actigraphy:
The Federal Register recently announced that a price has been provided for CPT Code #95803 – “Actigraph testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording” -- namely, $162.41without any geographic adjustments (total RVU’s being set at three times the conversion factor of $33.9764
Since CPT Code #95803 has both a professional and technical component, both facility and professional claims for actigraph testing can be submitted. If billed by a doctor’s office, a claim for actigraphy can be made without the use of a modifier, which means that such claim represents both the professional and technical components of the service.
If professional services are provided solely for data interpretation and report, then such service can be reported by adding Modifier 26 to the code (i.e., #95803-26). In most cases claims for the technical component of the service will be submitted by facilities -- in which case a modifier will have to be added (i.e., #95803-TC).
In addition to the actigraphy service itself, claims for ancillary services and supplies may also be eligible for reimbursement. Let’s say, for example, a patient is seen in the doctor’s office to discuss his or her actigraph record. In this case an Evaluation and Management Code (E&M) may be appropriate to report such doctor/patient encounter. Moreover, if this patient’s actigraph record is discussed in addition to other healthcare issues, the encounter may allow for a higher level E&M code than would normally be billed. Replacement actigraph wristbands and batteries provided to a patient may also be reported by healthcare providers (although some payers such as Medicare may not cover such a charge since they would consider supplies to be bundled into the actual actigraph service payment). The following codes may, however, be appropriate for reporting actigraph services and supplies:
- CPT Code 99203 – Office or other outpatient visit for the evaluation
and management of a new patient, which requires the following three
key components: a detailed history, a detailed examination, and
medical decision-making of low complexity.
- CTP Code 99211 -- Office or other outpatient visit for the evaluation
and management of an established patient, which may not require the
presence of a physician. Usually the presenting problem(s) are
minimal and, typically, five minutes are spent performing or
supervising this service.
- CPT Code 99245 – Office consultation for a new or established
patient, which requires these three key components: an
expanded problem-focused history, an expanded problem-focused
examination, and straightforward medical-decision making.
- CTP Code 99070 -- Supplies or materials (except spectacles)
provided by the physician over and above those usually included
with the office visit or other services rendered (list drugs, trays,
supplies, or material provided).
In addition to CPT Code 99070 some payers may also require one or
more of the following HCPCS Level II codes for supplies:
- A9900 Miscellaneous DME supply, accessory, and/or
Service component of another HCPCS Code
- A9901 DME delivery, set-up, and/or dispensing service
Component of another HCPCS Code
- A9999 Miscellaneous DME supply or accessory not
Note that some payers may not recognize Code #95803 since it is fairly new; and thus it is important for all providers to be aware of this and to use CPT Code #95803 – and not the old code for actigraphy, namely, #0089T. In addition, it is recommended that healthcare providers verify recommended coding guidelines with payers prior to submitting claims.
Documentation with regard to indications for actigraph testing and the parameters measured may be requested by payers in order to demonstrate the medical necessity for the service. This could include a patient’s sleep complaints, his or her resulting daytime sleepiness, insomnia and nighttime arousals, periodic leg movements, phase shifting and compliance follow-up. The following are examples of indications when actigraphy may be used to evaluate the condition of a patient; payer policy and coverage requirements should be verified prior to providing actigraph services for these and/or other conditions.
In order to recommend proper treatment for a patient presenting with hypersomnia or insomnia-like symptoms, documentation of the patient’s sleep/wake history is necessary. In such case several days and nights of actigraph recording can indicate the presence or absence of circadian rhythm disorders, poor sleep hygiene, daytime napping, and frequent waking; and such testing may indicate that overnight in-lab PSG testing is not required.
An actigraph placed on a subject’s ankle can identify the extent and frequency of periodic leg movement during that person’s sleep; and, again, such test may indicate overnight polysomnography is not required.
Actigraphy is helpful when it comes to daytime sleepiness complaints since actigraph testing can identify the occurrence and length of daytime naps and nighttime sleep irregularities. It recognizes sleep-related periodic body movements often associated with obstructive sleep apnea, which might require in-lab psg follow-up.
Actigraphy is a good detector for follow-up with regard to treatment efficacy since obstructive sleep apnea results in the characteristic movements recognized by actigraphy and treatment with Continuous Positive Airway Pressure (CPAP), which helps to eliminate these motions, can be objectively documented by actigraphy.