This coding and billing guidance applies to Highmark BCBS Medicaid and HARP members and NY providers.

Effective for any DOS 4/1/26 and thereafter MMC and HARP members that are 18 years and over, have a new benefit – home sleep study.

Billing guidance: the following codes should be used to bill for the home sleep study and need to havs modifier SE on the claims. Any claims without the SE modifier will be denied.

• G0398 — Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort, and oxygen saturation
• G0400 — Home sleep study test (HST) with type IV portable monitor, unattended; minimum of 3 channels
• G0399 — Home sleep study test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart

EXCLUSION- THIS benefit does not apply to CHP and Essential Plans (NY).

Do you find this content useful? Follow my blog for more!

Need reference guides? Check out CART-T or Allergy Treatment and testing reference guides- now available for download!

• Highmark BCBS: home sleep study billing
• Salvation Army members: new insurance cards
• UHC Community health: prior auth for some electrical stimulation services
• Rhode Island Medicaid: update telehealth PT services
• Aetna Better Health NJ: new bundled oncology condition specific prior auth