Coverage for Home Sleep Study (Proc Codes 95800, 95801, and 95806)

By November 14, 2025: (1) Billing team must update billing system to recognize CPT codes 95800, 95801, and 95806 for Arkansas DHS/MEDSV plans and enter the new reimbursement rates (95800: $110.40 standard/$35.51 mod 26/$74.89 TC; 95801: $84.52 standard/$36.90 mod 26/$47.63 TC; 95806: $83.77 standard/$39.76 mod 26/$44.01 TC). (2) Providers must verify that any ordering physicians are board-certified in sleep medicine and that technologists conducting home studies are certified sleep technologists or board-certified sleep specialists; document this credentialing in the practice. (3) Medical coders/billers must implement medical necessity checks before claim submission to ensure patients meet coverage criteria (age 16+, high OSA risk, no contraindicated conditions). (4) Create a prior to service verification process to confirm coverage criteria are met; document all eligibility checks. (5) Update encounter templates and order forms to capture required clinical information (patient age, OSA risk factors, exclusionary conditions). Claims billed without proper medical necessity documentation or from non-credentialed providers will be subject to denial and/or retrospective audit.