How To Use HCPCS Code G0400

HCPCS code G0400 describes a home sleep test (HST) with a type IV portable monitor, which is used to diagnose sleep disorders in patients. This code is specifically for unattended tests that require a minimum of three channels to monitor various physiological parameters during sleep. In this article, we will explore the details of HCPCS code G0400, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G0400?

HCPCS code G0400 is used to identify a specific type of home sleep test (HST) with a type IV portable monitor. This test is performed in an unattended setting, meaning that the patient can undergo the test at home without the need for a sleep technician or healthcare professional present. The test requires a minimum of three channels to monitor various physiological parameters during sleep, such as airflow, oxygen saturation, and respiratory effort.

2. Official Description

The official description of HCPCS code G0400 is “Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels.” The short description for this code is “Home sleep test/type 4 porta.”

3. Procedure

1. The provider will provide the patient with the necessary equipment for the home sleep test, including the type IV portable monitor.
2. The patient will be instructed on how to properly set up and use the equipment during sleep.
3. During the sleep test, the type IV portable monitor will record various physiological parameters, such as airflow, oxygen saturation, and respiratory effort.
4. After the sleep test is completed, the patient will return the equipment to the provider for data analysis and interpretation.
5. The provider will review the recorded data and generate a report with the findings and diagnosis.

4. When to use HCPCS code G0400

HCPCS code G0400 should be used when a healthcare provider performs a home sleep test using a type IV portable monitor with a minimum of three channels. This code is specifically for unattended tests, where the patient undergoes the test at home without the presence of a sleep technician or healthcare professional. It is important to ensure that the test meets the specific criteria outlined in the code description to accurately use HCPCS code G0400.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0400, healthcare providers need to document the following:

• Medical necessity for the home sleep test
• Documentation supporting the use of a type IV portable monitor
• Recorded data from the sleep test
• Interpretation and diagnosis report

It is important to follow the specific billing guidelines and requirements set forth by the payer, such as Medicare or other insurance companies, to ensure proper reimbursement for the service.

6. Historical Information and Code Maintenance

HCPCS code G0400 was added to the Healthcare Common Procedure Coding System on March 13, 2008. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has remained unchanged since its inception.

7. Medicare and Insurance Coverage

HCPCS code G0400 is eligible for coverage by Medicare and other insurance providers. The pricing indicator code for this code is 13, which means that the price is established by carriers based on individual determination and carrier discretion. The multiple pricing indicator code for this code is A, indicating that it is not applicable as HCPCS priced under one methodology. It is important to verify coverage and reimbursement policies with the specific payer to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code G0400 should be billed:

1. A patient with suspected sleep apnea undergoes a home sleep test using a type IV portable monitor with a minimum of three channels.
2. A physician orders a home sleep test for a patient with symptoms of insomnia to evaluate their sleep patterns and identify any underlying sleep disorders.
3. A patient with a history of restless leg syndrome undergoes a home sleep test to assess their sleep quality and determine if there are any contributing factors to their symptoms.
4. A healthcare provider recommends a home sleep test for a patient who lives in a remote area and has limited access to sleep clinics or facilities.
5. A patient with excessive daytime sleepiness undergoes a home sleep test to investigate the potential causes of their symptoms.