J893 – Multiple sleep latency test
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
J893 is a Multiple Sleep Latency Test (MSLT), which is a type of daytime sleep study. The fee is split into a professional component (P Fee) and a technical component (H Fee).
As per , the technical component of a diagnostic procedure is only eligible for payment where:
1. the physician has the necessary training and experience to personally render the technical component of the service; and
2. the physician maintains documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
Also, if the recording does not contain information sufficient for a diagnostic interpretation as determined in accordance with CPSO Standards, the service is not eligible for payment.
The technical component (H) rendered outside of a hospital is not eligible for payment under the Health Insurance Act.
When to Use
- Use J893 when performing a formal daytime nap study to objectively measure sleep latency in patients suspected of narcolepsy or idiopathic hypersomnia.
- Use this code specifically for the daytime MSLT component, ensuring it is distinct from the overnight polysomnography (J896 or J897) performed the preceding night.
Common Pitfalls
- Billing the technical component (H) for a study performed in a private clinic or non-hospital setting will result in an automatic rejection.
- Submitting J893 alongside any EEG codes (e.g., G414, G541) for the same patient on the same day is a prohibited billing combination that triggers claim rejection.
- Attempting to bill J893 and J894 on the same day is disallowed, as the ministry considers these mutually exclusive diagnostic procedures.
Billing Tips
- Ensure the professional component (P) is claimed by the interpreting physician while the technical component (H) is claimed only if the facility is hospital-based and the physician meets the quality assurance documentation requirements.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Diagnostic
Diagnostic and Therapeutic Procedures
If the recording does not contain information sufficient for a diagnostic interpretation as determined in accordance with CPSO Standards, the service is not eligible for payment.
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