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Sleep Studies to Require Preauthorization 

Date:
June 28, 2019

Diagnostic sleep studies will require preauthorization for all dates of service on or after September 1, 2019.

We want to ensure that our BlueShield of Northeastern New York Commercial and Medicare Advantage patients receive sleep studies in the location that provides the greatest value and that is tailored to pre-existing medical conditions they may have. Services that will require preauthorization include:

  • Home sleep test and associated equipment 
  • In-lab sleep study
  • Titration study

Codes that will require preauthorization are:

  • 95782-3
  • 95800-1
  • 95805-8
  • 95810-11
  • G0398-400

Services performed in conjunction with emergency room services, inpatient hospitalization, and urgent care facilities are excluded.

Please follow our standard preauthorization request process for all diagnostic sleep studies performed on or after September 1, 2019.

  • Download, complete and fax the “Preauthorization Form: Outpatient Services” here
  • Log in and visit our Code and Comment tool to search codes and get direction on corresponding medical protocols

If you have any questions, please contact your BlueShield account representative. 

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