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G0399

PAYER POLICY CHANGES

G0399 Insurance Policy Changes

HCPCS G0399 is officially defined as "Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation." HCPCS G0399 is referenced in 9 tracked payer policy changes from Arizona Medicaid - AHCCCS, Independence Blue Cross, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS G0399 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Arizona Medicaid - AHCCCS · Effective Aug 24, 2026High impact
AHCCCS DFSM Claims Clues - August 2026
Already effective August 24, 2026, AHCCCS prepayment reviews claims for H2038 (skills training and development, per diem) billed without a group modifier, and supporting medical documentation must be submitted with the initial claim and every replacement claim. Already effective September 4, 2026, the Alivia analytics tool reviews NEMT trip tickets and a set of claim edits, and claims containing the listed errors will be denied. Already effective September 1, 2026, claims submitted by fee-for-service providers that include a referring, ordering, attending or prescribing provider who is not registered with AHCCCS will be denied.
Independence Blue Cross · Effective Sep 19, 2026Medium impact
07.03.05ac, Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies
Independence Blue Cross has updated policy 07.03.05ac to delegate sleep disorder testing and PAP therapy utilization management back to Carelon Medical Benefits Management (previously delegated to AIM Specialty Health). Six procedure codes (CPT 95800, 95801, 95806 and HCPCS G0398, G0399, G0400) have been removed from the policy. The policy emphasizes requirements for standard written orders, proof of delivery, and adherence to Carelon's Clinical Appropriateness Guidelines for medical necessity determination.
Independence Blue Cross · Effective Sep 19, 2026Medium impact
07.03.05ac, Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies
Independence Blue Cross has updated policy 07.03.05ac effective 09/19/2026 to delegate sleep disorder testing and PAP therapy utilization management to Carelon Medical Benefits Management. Six procedure codes (CPT 95800, 95801, 95806 and HCPCS G0398, G0399, G0400) have been removed from the policy. Minor narrative revisions were made to HCPCS codes A7032 and A7046 regarding replacement supply descriptions.
Nevada Medicaid · Effective Feb 23, 2026Medium impact
Attention Provider Type 74 (Nurse Midwife): Sleep Codes G0398, G0399 and G0400 Cannot Be Billed
Nevada Medicaid has corrected an error that previously allowed Nurse Midwives (Provider Type 74) to bill sleep study codes G0398, G0399, and G0400. These codes are now properly denied for this provider type and cannot be billed going forward.
Nevada Medicaid · Effective Jan 26, 2026Medium impact
Attention Provider Types 20 (Physician, M.D., Osteopath D.O.), 24 (Advanced Practice Registered Nurses), and 77 (Physician’s Assistant): Rates for Procedure Codes G0398, G0399, and G0400 Submitted with Modifiers TC and 26
Nevada Medicaid has added reimbursement rates for home sleep test codes G0398, G0399, and G0400 when billed with modifiers TC and 26 by physicians, nurse practitioners, and physician assistants. Claims with these modifier combinations will now be paid appropriately starting January 26, 2026.
Nevada Medicaid · Effective Jan 12, 2026Medium impact
Attention Provider Types 24 (Advanced Practice Registered Nurses), 74 (Nurse Midwife) and 77 (Physician’s Assistant): Procedure Codes G0398, G0399, and G0400 Opened for Billing (Updated February 23, 2026)
Nevada Medicaid has opened billing for home sleep test codes G0398, G0399, and G0400 for Advanced Practice Registered Nurses (Type 24) and Physician Assistants (Type 77) effective January 12, 2026. Note that Nurse Midwives (Type 74) cannot bill these codes per a subsequent update.
Aetna · Identified Oct 12, 2026Medium impact
Obstructive Sleep Apnea in Adults (CPB 0004, reviewed 2026-10-06)
Aetna considers attended full-channel polysomnography medically necessary for adults with symptoms suggestive of obstructive sleep apnea when a listed indication applies and the study is part of a comprehensive sleep evaluation with adequate follow-up, and considers unattended home sleep studies medically necessary when they use a Type II, III or IV device that measures the apnea-hypopnea index (AHI). CPAP, CPAP with pressure relief technology, autoPAP and APAP are medically necessary for members with a positive facility-based or home sleep test when the AHI or RDI is 15 or more events per hour with at least 30 events, or 5 to less than 15 events per hour with at least 10 events plus one listed condition, such as documented stroke, hypertension, ischemic heart disease, impaired cognition or mood disorders, insomnia, excessive daytime sleepiness, or more than 20 desaturations below 85% or any single desaturation below 70% during a full night study. Mandibular advancement oral appliances and FDA-approved hypoglossal nerve neuro-stimulation are considered medically necessary only when their listed criteria are met, and many other tests, devices and procedures are listed as experimental, investigational, unproven or not medically necessary.
Aetna · Identified Aug 12, 2026Medium impact
Obstructive Sleep Apnea in Adults (CPB 0004, reviewed 2026-07-21)
Attended full-channel polysomnography performed in a healthcare facility is medically necessary for diagnosing obstructive sleep apnea in adults aged 18 and older when specific criteria are met. Unattended home sleep studies using a Type II device, a Type III device, a Type IV(A) device that measures airflow and AHI, or a device with 3 or more channels including pulse oximetry, actigraphy and peripheral arterial tone (such as Watch-PAT) are medically necessary for members with symptoms suggestive of OSA. CPAP and autoPAP are medically necessary when a facility-based or home sleep test shows an AHI or RDI of 15 or greater with at least 30 events, or 5 to 14 with at least 10 events plus a listed comorbidity or excessive daytime sleepiness, and hypoglossal nerve stimulation, oral appliances and several surgical procedures are covered when their listed criteria are met.
Independence Blue Cross · Identified Jun 19, 2026Low impact
MA07.028, Home-Based Sleep Studies
Independence Blue Cross reissued MA07.028 (Home-Based Sleep Studies) on 07/22/2026 with no substantive changes to coverage criteria, billing codes, or documentation requirements. The policy continues to cover home-based sleep testing for OSA diagnosis and follow-up studies under Medicare Advantage plans in New Jersey when medical necessity criteria are met. This is a routine annual review reissuance with no billing workflow impact.

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REFERENCE DATA

Payers with rules9

Payers requiring prior auth9

Anthem BCBS · Effective November 1, 2026
Prior authorization required
Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)
Elevance Health · Effective February 11, 2026
Prior authorization required
List of items and services that require prior authorization (Medicaid LA)
BCBS Illinois · Effective January 1, 2026
Prior authorization required in some cases
2026 Commercial Outpatient Medical Surgical Prior Authorization Codes

FREQUENTLY ASKED QUESTIONS

Does Anthem BCBS require prior authorization for G0399?

Anthem BCBS lists G0399 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for G0399?

Arizona Complete Health lists G0399 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Illinois require prior authorization for G0399?

BCBS Illinois lists G0399 on 2026 Commercial Outpatient Medical Surgical Prior Authorization Codes for commercial plans, with conditions (list dated January 1, 2026). Verify with the payer before scheduling.

Does BCBS New Mexico require prior authorization for G0399?

BCBS New Mexico lists G0399 on 2026 Commercial Outpatient Medical Surgical ASO Medical Surgical Procedure Code List for commercial plans, with conditions (list dated January 1, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for G0399?

CalViva Health lists G0399 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS G0399?

There are 9 tracked policy changes affecting HCPCS G0399, including updates from Arizona Medicaid - AHCCCS, Independence Blue Cross, Nevada Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS G0399?

Payers that have issued tracked updates for HCPCS G0399 include: Arizona Medicaid - AHCCCS, Independence Blue Cross, Nevada Medicaid, Aetna.

How do I get notified when HCPCS G0399 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS G0399. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS G0399?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for G0399 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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AHCCCS DFSM Claims Clues - August 2026

07.03.05ac, Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies

07.03.05ac, Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies

Attention Provider Type 74 (Nurse Midwife): Sleep Codes G0398, G0399 and G0400 Cannot Be Billed

Attention Provider Types 20 (Physician, M.D., Osteopath D.O.), 24 (Advanced Practice Registered Nurses), and 77 (Physician’s Assistant): Rates for Procedure Codes G0398, G0399, and G0400 Submitted with Modifiers TC and 26

Attention Provider Types 24 (Advanced Practice Registered Nurses), 74 (Nurse Midwife) and 77 (Physician’s Assistant): Procedure Codes G0398, G0399, and G0400 Opened for Billing (Updated February 23, 2026)

Obstructive Sleep Apnea in Adults (CPB 0004, reviewed 2026-10-06)

Obstructive Sleep Apnea in Adults (CPB 0004, reviewed 2026-07-21)

MA07.028, Home-Based Sleep Studies

Prior authorization required