sleep medicine services

New Physician Specialty Code for Sleep Medicine and Sports Medicine

Effective April 2, 2012, Providers will need to use physician specialty code (C0) for sleep medicine services. In addition, claims submitted to DME MACs for sports medicine service should use the sports medicine specialty code of 23.

Medicare physician and non-physician practitioner specialty codes describe the specific or unique types of medical services that physicians and non-physician practitioners provide. While physicians self-designate their Medicare physician specialty on the Medicare enrollment application (CMS-855I) or Internet-based Provider Enrollment, Chain, and Ownership System (PECOS) when they enroll in the Medicare program, non-physician practitioners are assigned a Medicare specialty code when they enroll. The specialty code becomes associated with the claims submitted by physicians or non-physician practitioners. Medicare contractors also use specialty code data to develop claims processing edits.

The Centers for Medicare & Medicaid Services (CMS) has established a new physician specialty code for Sleep Medicine. This new physician specialty code, which will be effective April 2, 2012, is C0. PECOS and your carrier or A/B MAC will recognize and use this new code as a valid primary and/or secondary specialty code for Sleep Medicine. Also, a new specialty code is established for sports medicine and that code is 23.


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