Navigate the 2026 CMS -2.5% efficiency adjustments and complex PSG/HSAT cross-walks with expert-led sleep medicine RCM. Even experienced billers can get tripped up by these complex policies. With our sleep medicine billing experts, you don’t have to worry. We reclaim your lost revenue, reduce your A/R days, and guarantee that every polysomnography study is coded, documented, and billed accurately.
We bill for independent sleep physicians, pulmonologists, neurologists, and dental sleep medicine providers. Our services support independent sleep labs, hospital-affiliated labs, pediatric programs, and both IDTF and non-IDTF entities. All workflows follow the specific billing, enrollment, and supervision rules required for each structure.
Dastify Solutions is a U.S.-based sleep medicine billing partner, helping practices master the complex billing requirements for dental sleep medicine, home sleep testing, polysomnography, pediatric sleep studies, and related procedures.
We keep your sleep practice safe from penalties by:
Medical Necessity Compliance
Accurate Time-Based Coding
CMS & Payer Policy Adherence
Denial Pattern Monitoring
Duplicate & Unbundled Billing Prevention
Credentialing & Supervision Compliance
Home Sleep Testing Eligibility Control
Documentation Completeness Checks
HIPAA-Compliant Billing Processes
Keeping patients compliant with CPAP or BiPAP therapy is critical. With the new 2026 CPT codes (99445 and 99470), we capture short-duration remote monitoring (2–15 days), ensuring you get paid for data transmission from CPAP/BiPAP devices that standard billing processes often ignore.
At Dastify Solutions, we ensure every eligible monitoring session is reimbursed so you can focus on patient care.
Maximizes revenue by billing what other billers skip.
Supports patient care by remotely tracking adherence.
Streamlines compliance with the latest CPT updates.
Patient Registration & Eligibility Verification
We verify insurance coverage in real time, manage sleep study authorizations, and update patients on their benefits, copays, and deductibles so you can start treating your patients without delay.
Polysomnography Coding & Charge Capture
Our team accurately codes diagnostic sleep studies, CPAP/BiPAP titration, split-night studies, home sleep apnea testing, and MSLT to ensure every service is billed correctly and fully captured. Our experts accurately use codes such as 95810, 95811, 95800, 95801, and 95806 to ensure successful reimbursements.
Claims Submission & Tracking
We handle prior authorizations for PSG, HSAT, titration studies, and follow-up testing with both Medicare and commercial payers. Missing or incorrect authorizations are among the most common reasons claims are denied, so we check approvals before services are performed, submit the required clinical records, and follow up on denied claims to recover payment.
Denial Management & Appeals
We manage sleep medicine denials from start to finish. Most denials result from missing authorizations, medical-necessity issues, frequency limits, or incomplete documentation. We review the reason for the denial, correct the problem, and submit appeals on time in accordance with the payer’s requirements to recover payment.
Patient Registration & Eligibility Verification
We verify insurance coverage in real time, manage sleep study authorizations, and update patients on their benefits, copays, and deductibles so you can start treating your patients without delay.
Payment Posting & Reconciliation
We deliver accurate sleep medicine payment posting by reconciling ERAs and EOBs, identifying underpayments, contractual variances, and payer takebacks, and flagging unpaid or misapplied claims for rapid follow-up and recovery.
Behavioral Sleep Medicine (BSM) Integration
Support for Behavioral Sleep Medicine (BSM) billing, including digital CBT-I frameworks and psychophysiological insomnia coding (90833-90837 add-ons).
Medical necessity validation Ensure documentation supports sleep testing based on symptoms, risk factors, and payer coverage criteria.
HSAT vs in-lab PSG compliance Bill HSAT only when payer criteria are met, and use in-lab PSG when HSAT is contraindicated or has failed.
Prior authorization accuracy Verify that authorizations match the exact study type, CPT code, and date of service.
Frequency limits and repeat study control Track payer limits for PSG, HSAT, and titrations and require documented justification for repeat testing.
Professional vs facility billing accuracy Correctly separate technical and professional components based on lab structure, supervision rules, and payer policy.
PAP therapy compliance and coverage Confirm sleep study results, adherence requirements, and continued medical necessity before billing PAP-related services.
Time-based E and M coding Validate total time, qualifying activities, and alignment with visit complexity to prevent downcoding and audits.
Modifiers and place of service Apply TC 26 and global billing rules correctly, and confirm the place of service to avoid automatic denials.
Medicare Sleep Study Billing
MAC-Specific LCD Compliance
Commercial Payer Authorization Workflows
Hospital-Based vs Independent Sleep Labs
In-Lab vs Home Sleep Testing
Multi-Location Sleep Clinic Billing
Our compliance-first sleep medicine billing review identifies authorization gaps, LCD violations, IDTF risks, and documentation weaknesses before they become penalties.
Most commercial payers and Medicare Advantage plans require prior authorization for PSG, HSAT, titrations, and repeat sleep studies. Missing or mismatched authorizations are a leading cause of sleep medicine denials
Payers enforce strict frequency limits. Repeat PSG, HSAT, or titrations are covered only when documentation shows treatment failure, persistent symptoms, or a significant clinical change.
We validate that the total time meets E and M thresholds, confirm that only qualifying provider activities are counted, and ensure that documentation supports the level billed under current payer rules.
