Updated sleep study precertification requirements

August 7, 2020

This article was revised on August 7, 2020, to update the portal access information.

As of July 18, 2020, AmeriHealth no longer requires precertification for home sleep study tests. Therefore, providers do not need to submit a precertification request to AIM Specialty Health® (AIM) in order to perform a home sleep study test.

The CPT® and HCPCS codes for services affected by this update are:

  • 95800
  • 95801
  • 95806
  • G0398
  • G0399
  • G0400

Submitting facility-based requests through AIM

Authorization is still required through AIM for in-lab/facility sleep studies. All precertification requests for facility-based sleep study tests should be submitted using AIM's ProviderPortalSM. Providers can access AIM's ProviderPortal through the NaviNet® web portal (NaviNet Open) by selecting Authorizations from the AmeriHealth Workflows menu, then AIM.

It is important for providers to use NaviNet Open to verify member eligibility and benefits, and to refer to the most current precertification requirement lists on our website. Failure to obtain precertification for services that require precertification may result in a reduction in payment or nonpayment for the services provided.

Policies

For more information about sleep testing services, please refer to the following AmeriHealth policies:

  • #07.03.01: Home Based Sleep Studies
  • #07.03.05x: Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies

To view these policies, visit our Medical Policy Portal.

Learn more

If you have questions related to services that require precertification through AIM, visit our dedicated web page for AIM.

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