How To Use CPT Code 95803

CPT 95803 describes the actigraphy testing, recording, analysis, interpretation, and report for assessing a patient’s rest and activity cycles over a period of 72 hours to 14 consecutive days. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 95803?

CPT 95803 can be used to describe the actigraphy testing, recording, analysis, interpretation, and report for evaluating a patient’s rest and activity cycles. This code is used when the provider utilizes an actigraph unit or sensor, typically worn on the wrist or ankle, to continuously measure the patient’s motor activity over a period of 72 hours to 14 consecutive days. The results are then transmitted to a computer for analysis and interpretation.

2. Official Description

The official description of CPT code 95803 is: ‘Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording).’

3. Procedure

1. During actigraphy testing, the patient wears an actigraph unit on their wrist or ankle.
2. The actigraph unit continuously measures the patient’s motor activity over a period of 72 hours to 14 consecutive days.
3. The recorded data is then transmitted to a computer for analysis and interpretation.
4. The provider analyzes the data to evaluate the patient’s rest and activity cycles.
5. A comprehensive report is generated, summarizing the findings of the actigraphy testing.

4. Qualifying circumstances

Patients who may benefit from actigraphy testing using CPT 95803 include those with suspected insomnia, circadian rhythm sleep disorders, excessive sleepiness, and restless leg syndrome. The testing should last a minimum of 72 hours and a maximum of 14 consecutive days. It is important to note that CPT code 95803 should not be reported more than once within a 14-day period.

5. When to use CPT code 95803

CPT code 95803 should be used when a provider performs actigraphy testing, recording, analysis, interpretation, and report for a patient’s rest and activity cycles. It is appropriate to bill this code when the testing duration falls within the range of 72 hours to 14 consecutive days. However, it should not be reported in conjunction with codes 95806 to 95811, as these codes are typically used for other sleep study procedures.

6. Documentation requirements

To support a claim for CPT 95803, the provider must document the following information:

• The reason for performing actigraphy testing and the suspected sleep disorder
• The duration of the testing period, which should be within the range of 72 hours to 14 consecutive days
• A detailed analysis and interpretation of the recorded data
• A comprehensive report summarizing the findings of the actigraphy testing

7. Billing guidelines

When billing for CPT 95803, it is important to note that the reimbursement amount may vary as it is carrier priced by CPT®. Providers should submit both facility and professional claims for actigraphy testing, as it has both a professional and technical component. It is crucial to ensure that CPT code 95803 is not reported more than once within a 14-day period. Additionally, it should not be reported in conjunction with codes 95806 to 95811, as these codes are typically bundled with actigraphy testing.

8. Historical information

CPT code 95803 was added to the Current Procedural Terminology system on January 1, 2009. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes actigraphy testing for 7 consecutive days to evaluate their sleep patterns and assess for circadian rhythm sleep disorders.
2. An individual wears an actigraph unit for 10 days to monitor their motor activity and determine the presence of restless leg syndrome.
3. A provider performs actigraphy testing for 5 days to assess a patient’s rest and activity cycles and diagnose excessive sleepiness.
4. An actigraph unit is worn by a patient for 14 consecutive days to evaluate their sleep patterns and diagnose insomnia.
5. A provider utilizes actigraphy testing for 3 days to assess a patient’s rest and activity cycles and determine the presence of circadian rhythm sleep disorders.
6. An individual undergoes actigraphy testing for 9 consecutive days to monitor their motor activity and diagnose restless leg syndrome.
7. A provider performs actigraphy testing for 6 days to evaluate a patient’s sleep patterns and assess for excessive sleepiness.
8. An actigraph unit is worn by a patient for 12 consecutive days to assess their rest and activity cycles and diagnose insomnia.
9. A patient undergoes actigraphy testing for 4 days to monitor their motor activity and determine the presence of circadian rhythm sleep disorders.
10. A provider utilizes actigraphy testing for 8 consecutive days to assess a patient’s sleep patterns and diagnose restless leg syndrome.