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PEDIATRIC SLEEP STUDY ORDER FORM - Legacy Health

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The document is a Pediatric Sleep Study Order Form for Randall Children's Hospital Sleep Center, detailing the necessary information and requirements for scheduling a sleep study for a patient. It includes sections for patient and physician details, required documents, indications for the study, order selection options, special instructions, and physician signatures.

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How to get a sleep study covered by insurance?

How Can I Get Insurance to Cover a Sleep Study? Make sure your sleep study is prescribed by your doctor. Make sure your test provider is in-network. See if you have met your deductible and if there will be copays. Know if at-home tests are covered vs lab tests.

Why would insurance deny a sleep study?

Lack of medical necessity Insurance companies and government programs may deny claims if they determine that the polysomnography or sleep study was not medically necessary. To address this challenge, healthcare providers should document the medical necessity of the test in the patients medical record.

Can a family doctor order a sleep study?

Your primary care physician or a physician at a sleep clinic can order it for you to use at home.

What diagnosis qualifies for a sleep study?

Sleep tests can help your doctor diagnose sleep-related breathing disorders such as sleep apnea, sleep-related seizure disorders, sleep-related movement disorders, and sleep disorders that cause extreme daytime tiredness such as narcolepsy.

How to get a sleep study approved by insurance?

To schedule a sleep study, you will need a referral from a physician and in some cases an authorization from your health insurance company. Sometimes, sleep lab staff can get approval from your insurance company on your behalf.

Do sleep studies require prior authorization?

Prior Authorization requests for Sleep Study codes (95800, 95806, 95801, G0398, G0399, G0400) will not require a Prior Authorization. Facility-based codes (95807, 95808, 95810, 95811) will require a Prior Authorization.

Are pediatric sleep studies covered by insurance?

The costs vary depending on the services required, the particular service provider, and the insurance provider, but for a service like an overnight sleep study, parents can expect an average cost of around $1000 to $2000 before insurance is applied. Insurance, including Medicare, can cover the majority of the cost.

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