July 28, 2025
A graphic titled Medical Coding Sleep Apnea with an image of a man sleeping with mouth open to illustrate snoring and a cutout of the blockage of his throat that is cutting off air

Medical Coding Sleep Apnea

AAPC | Certification | Certified Medical Coder | CPC | Medical Coding
By Janine Mothershed

Medical Coding and Billing Guidelines for Sleep Apnea

Sleep apnea is a common and serious sleep disorder that affects millions of Americans. Accurate billing and medical coding for sleep apnea are critical for ensuring proper reimbursement and compliance when documenting and treating sleep apnea. This article outlines key ICD-10, CPT, and HCPCS codes, documentation guidelines, and billing tips for sleep apnea services.

Understanding Sleep Apnea

Sleep apnea is a condition where breathing repeatedly stops and starts during sleep. There are three main types:

  • Obstructive Sleep Apnea (OSA) – Most common; caused by airway blockage.

  • Central Sleep Apnea (CSA) – Caused by brain signal failure to muscles that control breathing.

  • Complex or Mixed Sleep Apnea – Combination of OSA and CSA.

Common ICD-10-CM Codes for Sleep Apnea

When coding for sleep apnea, it’s essential to select the most specific diagnosis code:

  • G47.33 – Obstructive sleep apnea (adult) (pediatric)

  • G47.30 – Sleep apnea, unspecified

  • G47.31 – Primary central sleep apnea

  • G47.37 – Central sleep apnea in conditions classified elsewhere

Include relevant comorbid conditions, such as:

  • I10 – Essential (primary) hypertension

  • E66.9 – Obesity, unspecified

CPT Codes for Sleep Apnea Diagnosis and Treatment

Polysomnography (sleep studies) and PAP therapy (positive airway pressure) are central to sleep apnea diagnosis and treatment.

Diagnostic Sleep Studies:

  • 95800 – Sleep study, unattended, simultaneous recording

  • 95801 – Sleep study, unattended, minimum of 4 parameters

  • 95806 – Sleep study, unattended, respiratory analysis

  • 95810 – Polysomnography; attended, with continuous recording

  • 95811 – Polysomnography; with CPAP/BiPAP titration

Medical Coding Home Sleep Study https://codingclarified.com/medical-coding-home-sleep-study/

PAP Therapy and Follow-Up:

  • 94660 – Continuous positive airway pressure (CPAP) ventilation initiation and management

  • 94662 – Continuous negative pressure ventilation

  • 99441–99443 – Telephone E/M (used in follow-ups, if applicable)

HCPCS Codes for PAP Equipment and Supplies

Durable Medical Equipment (DME) codes are crucial for billing PAP therapy:

  • E0601 – CPAP device

  • A7030–A7039 – Supplies like masks, tubing, filters, and headgear

  • E0470 – BiPAP device (without backup rate)

  • E0471 – BiPAP device (with backup rate)

Ensure frequency and replacement intervals are supported by payer policies.

What is HCPCS in Medical Coding https://codingclarified.com/what-is-hcpcs-in-medical-coding/

Medical Coding HCPCS Medical Supplies https://codingclarified.com/medical-coding-hcpcs-medical-supplies/

Billing and Documentation Tips

  • Medical Necessity: Clearly document symptoms (e.g., daytime sleepiness, snoring), physical findings, and results of sleep studies.

  • Preauthorization: Many payers require prior authorization for sleep studies and DME.

  • Split-night Studies: If using CPT 95811 for split-night study (diagnostic + CPAP titration), ensure clear documentation of criteria met for CPAP initiation.

  • Compliance Monitoring: Continued use of PAP devices often requires proof of patient compliance (e.g., ≥ 4 hours/night on 70% of nights in 30 days).

  • Diagnosis Linking: Always link ICD-10 diagnosis codes appropriately to each CPT or HCPCS code billed.

  • Follow-Up Visits: Include documentation of treatment effectiveness, equipment issues, and patient adherence.

Payer-Specific Considerations

Medicare and private insurers may have differing guidelines on:

  • Sleep study types (in-lab vs. home sleep test)

  • PAP therapy trial periods and re-evaluations

  • Frequency of replacement supplies

Review payer LCDs (Local Coverage Determinations) or policies before submitting claims.

Proper coding and billing for sleep apnea require thorough documentation, accurate code selection, and awareness of payer policies. Staying updated on evolving guidelines and maintaining communication with providers and DME suppliers ensures successful reimbursement and continuity of care for sleep apnea patients.

CMS Billing and Coding: Surgical Treatment of Obstructive Sleep Apnea https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56905&ver=17

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