Reimbursement

PAP-NAP in a Nutshell

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What is at PAP-NAP? It’s an abbreviated daytime sleep study using PAP therapy to desensitize patients whose anxiety is likely to cause sleeping with the device to fail. It is attended by a technologist and records at least four channels of data.

How do I bill it? There aren’t any codes in the Current Procedural Terminology (CPT) codebook that specifically describe the PAP-NAP service. Some payors have recognized CPT code 95807 (sleep study-attended) to bill the service but, as the AASM notes, that code only approximately reflects the service that is being performed. Because the event typically lasts under 4 hours, providers use the “-52” modifier to indicate a reduced (less than full 6-hour) sleep study.

Will I get paid? Medicare. There is no Medicare coverage determination or other reimbursement guidance addressing PAP-NAPs. However, Medicare has historically reimbursed the PAP-NAP service when billed as 95807-52.

Commercial Payors. Different commercial payors have taken different reimbursement positions at different times. A handful of commercial insurance payors now specifically recognize PAP-NAPs—but in a negative way. Persons seeking to perform PAP-NAPs should communicate with the payor’s medical director or other policy personnel to obtain consent for payment of the service and use of the 95807 code.

Daniel B. Brown, Esq, is the founding member of The Daniel Brown Law Group, LLC, in Atlanta, and is a member of Sleep Review’s editorial advisory board. Submit questions about the article to sleepeditor@nullallied360.com.

For more in-depth information about the PAP-NAP, read Preparing for the PAP-NAP.