ActiGraph’s innovative actigraphy monitoring system delivers 24-hour, real world information about sleep/wake behavior, circadian rhythms, and daytime physical activity. With its ability to capture high quality continuous sleep/wake data for days and weeks at a time, the ActiGraph system is a cost-effective and noninvasive in-home monitoring solution that offers a level of accuracy and reliability that cannot be achieved through subjective patient reports.
Category 1 (CPT) Code 95803 has been approved for the use of actigraphy.
Code 95803 Description: Actigraph testing, recording, analysis, interpretation, and report (a minimum of 72 hours to 14 consecutive days of recording, requires a patient to wear a home monitor for 24 hours a day for 3 to 14 days)
In 2011 Medicare increased its reimbursement for the technical component of the test by 56% over the previous years’ amount. Medicare now pays approximately $115 for the technical component and $46.89 for the professional component, yielding a global Medicare reimbursement for actigraphy of about $162 per test.*
Actigraphy (95803) was released under Contract Carrier Pricing; therefore, coverage guidelines have not yet been issued by the Centers for Medicare and Medicaid Services (CMS) and current coverage/reimbursement varies by jurisdiction.
All CMS sleep related codes have been under review (including actigraphy) since early 2010. We are hopeful and it is anticipated that a revised reimbursement schedule will be released in late fall with coverage guidelines commencing in January of 2011.
Claims for other ancillary services, such as Evaluation and Management (E&M) or replacement supplies and professional/technical components may be eligible for reimbursement in addition to the actigraphy service, but it is not completely certain at this time.
Documentation of patient sleep complaints may be requested by payers to verify the medical necessity of actigraphy testing. Actigraphy may be useful for the evaluation of conditions such as insomnia/hypersomnia, daytime sleepiness, periodic leg movement disorder, and CPAP compliance. Many have found it helpful to verify payer policy and coverage requirements prior to providing actigraphy services. However, utilizing the appeals process post a rejection for reimbursement, has also been reported with moderate success.
*Medicare information furnished courtesy of Sleep Review Magazine. For more information, contact the ActiGraph Sales Department.