Summary & Overview
CPT 94776: Pediatric Home Apnea Monitoring Review, 30-Day
CPT code 94776 captures clinician review and analysis of pediatric home apnea monitoring data collected over a 30‑day period, including respiratory rate, respiratory pattern, and heart rate. This service formalizes remote review workflows that support post-discharge monitoring, evaluation of recurrent apnea events, and longitudinal assessment of infant cardiorespiratory status. Nationally, formal billing pathways for home physiologic monitoring enable clearer documentation, care coordination, and potential reimbursement for clinicians who review device-generated transmissions and computer-processed summaries.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The coverage landscape among major payers affects access to structured remote monitoring programs and influences program design for pediatric practices and telemonitoring vendors.
Readers will learn what CPT code 94776 represents clinically and operationally, how it fits into remote physiologic monitoring workflows, and what to expect from typical site-of-service arrangements (home monitoring with outpatient or remote clinician review). The publication also outlines benchmark themes and policy considerations relevant to national payers and summarizes the clinical context for pediatric apnea surveillance. Data not available in the input will be noted where specific payer policies, associated taxonomies, and ICD-10 mappings are required.
Billing Code Overview
CPT code 94776 describes a service that reviews pediatric home apnea monitoring parameters over a 30–day period. The service encompasses monitoring, downloading transmitted data, receiving transmission(s), and computer analyses of key signals such as respiratory rate, respiratory pattern, and heart rate.
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Service type: Remote physiologic monitoring review and analysis of pediatric apnea/home cardiorespiratory data over a defined 30-day monitoring period.
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Typical site of service: Home-based monitoring with clinician review occurring in an outpatient or remote clinical setting where downloaded transmissions and computer-generated analyses are reviewed.
Clinical & Coding Specifications
Clinical Context
A typical patient is an infant or young child being followed for recurrent apparent life-threatening events (ALTE), suspected central or obstructive apnea, or prematurity-related apnea. The child has been discharged home with a pediatric home apnea monitor that records respiratory rate, respiratory pattern, oxygen saturation, and heart rate. Over a 30‑day surveillance period the monitor records events which are transmitted or downloaded to the treating pediatrician, neonatologist, or pediatric pulmonology service. Clinical workflow: the home monitor vendor or caregiver uploads transmitted data to a secure portal; a qualified clinician or trained respiratory therapist retrieves and reviews the downloaded recordings and the device’s computerized analyses; documented review includes event frequency, duration, bradycardia or desaturation occurrences, and any recommended follow-up; results are incorporated into the patient’s chart and communicated to the family with instructions or referral as appropriate. Typical site of service is outpatient or ambulatory setting, including pediatric clinic, neonatology clinic, home health service coordination, or remote monitoring service center.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Use when no special circumstances apply. |
| 22 | Increased procedural services | Use when complexity of review or extensive additional physician work beyond typical interpretation is documented.