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Supported Line of Business: Commercial & Medicare Advantage

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An unattended, at-home diagnostic test ordered by a clinician to evaluate for obstructive sleep apnea (OSA) — submitted to Bridge as a billable service, distinct from the E/M visits that precede and follow it.

📌 This service line has a coding change coming January 1, 2027 — i.e. the existing CPT codes will be replaced with unknown code sets. Bridge will stay close to these changes and communicate impact to Partners as applicable.

Overview

A Sleep Study is not a visit type — it's a diagnostic service that sits inside a three-part clinical path:

  1. Pre-Diagnosis visit — a standard E/M encounter where the clinician evaluates symptoms and orders the sleep study. The order should be in the Plan section of the SOAP note format, alongside any other labs, Rx, imaging applicable orders.
  2. Sleep Study — the test & results itself, submitted to Bridge as a service, (billed as CPT 95800.)
  3. Post-Study Follow-Up visit — a standard E/M encounter where the clinician reviews results and finalizes diagnosis coding and treatment plan based on the Sleep Study results.

The key distinction from other service lines: The Sleep Study service is not billed or leveled like an E/M visit or an element-based code (compare to Cognitive Assessment's 10-element requirement). It's billed as a discrete diagnostic service, and its documentation requirements are structured around the device output rather than MDM, time, or required elements.

Dimension Pre-Diagnosis Visit Sleep Study (Service) Post-Study Follow-Up Visit
Billing code Standard E/M (99202–99215) Sleep Study (95800) Standard E/M (99202–99215)
Submitted as SOAP chart note Service note SOAP chart note
Diagnosis coding Symptom-based (avoid definitive OSA codes) Reflects study indication Definitive (G47.33) if OSA confirmed in the study

Consent Requirements

Standard Bridge telehealth consent applies to the Pre-Diagnosis and Post-Study Follow-Up E/M visits (see Service Line Guide: Medical (E&M) for more details on submitting E/M visits to Bridge.)

There isn't a separate signed consent form required specifically for the at-home testing device. The one device-specific requirement to document is patient instruction: the patient must receive both written and verbal instruction on proper use of the portable monitoring device before the study. This is captured in the Sleep Study Note's "Description" field (see below) and should be documented for every study.

Service Frequency & Scope

Category Details
Payer eligibility Home sleep apnea testing is generally covered under Medicare Part B, Medicare Advantage, and most commercial plans when medically necessary. Confirm your specific supported line of business with your Bridge Onboarding contact.
Provider types The test must be ordered by a licensed medical provider following a face-to-face (in-person or telemedicine) history and exam. Raw device data must be reviewed and interpreted by a physician who is board-certified in sleep medicine, or overseen by one. NPs and PAs are widely recognized in clinical practice as qualified to perform the HSAT clinical evaluation.
Pre-test workup required Home sleep testing is only appropriate when performed alongside a comprehensive sleep evaluation, in patients with a high pretest probability of moderate-to-severe OSA. This is exactly what the Pre-Diagnosis E/M visit should establish and document.
Comorbidity exclusions Home testing is not appropriate for patients with certain comorbidities such as moderate-to-severe pulmonary disease, neuromuscular disease, or congestive heart failure. These patients generally need an in-lab polysomnography referral instead of an at-home study.
Service frequency There's no fixed numeric cap the way there is for some other service lines. Repeat testing is covered when medically necessary and documented accordingly; some commercial and Medicare Advantage plans limit repeat testing to roughly once every 1-2 years absent documented medical necessity. Recognized reasons for a follow-up study include evaluating treatment efficacy, significant weight loss or gain, or symptoms returning despite initial improvement. Confirm your program's specific frequency policy with your Bridge contact.
Prior authorization ~25% of Sleep Studies require a PA, varies by payer mix (see below)
Telehealth delivery (surrounding visits) Synchronous audio-video required for Pre-Diagnosis and Follow-Up E/M visits. (Work with your Bridge Onboarding contact if you anticipate challenges with certain patient populations.)

Prior Authorizations