Sleep Studies
Posted on November 23, 2015
Health New England has contracted with eviCore healthcare to preauthorize specific sleep diagnostic procedures and PAP therapy devices and supplies. eviCore currently administers prior authorizations for our High Cost Radiology and Imaging testing. Our partnership with eviCore healthcare will help HNE to improve the quality and appropriateness of these services while reducing variations that exist in the utilization of these services.
Beginning on February 1, 2016, HNE will be expanding prior authorization requirements for our Commercial, Medicare Advantage and HNE BeHealthy! members to the following outpatient sleep procedures, PAP therapy devices, and PAP supplies:
• Sleep Diagnostics including attended sleep studies (95810, 95811,95805, 95807, 95808) and Home Sleep Testing (95806, G0399)
• PAP Therapy including HCPCS codes E0601, E0470, and E0471
• PAP Therapy Supplies
Prior Authorization Process
EviCore will review requests for authorization of coverage of diagnostic sleep studies and PAP equipment using evidence-based guidelines supported by CMS as well as the American Academy of Sleep Medicine. Beginning January 15, 2016, physicians may request a prior authorization for outpatient sleep services for dates of service on or after February 1, 2016, by contacting EviCore at (866) 889-8056 or www.evicore.com.
This program is designed to enhance sleep services by ensuring the appropriate use of home sleep testing supporting a cost-effective, comprehensive, Obstructive Sleep Apnea program. This new requirement will not change where you currently submit your claims. For additional information, please log onto HNEtalk or call HNE Provider Relations at (413) 233-3313 or (800) 842-4464, ext. 5000.
• HNE eviCore Announcement
• HNE eviCore FAQ’s
• HNE eviCore Provider Overview Power Point Presentation
• HNE eviCore Codes Requiring Authorization
