Billing code
J897C — Level 1 sleep study – repeat diagnostic
Repeat diagnostic overnight sleep study
Bill J897 for a repeat overnight Level 1 diagnostic sleep study, for a second opinion or a listed re-evaluation, after a sleep physician's assessment.
Watch for: One per patient per facility per 12 months, and not at the facility that did the initial study within 12 months, without prior approval.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $0.00 | $0.00 | $430.55 | $97.50 | $97.50 |
- Code
- J897C
- Description
- Level 1 sleep study – repeat diagnostic
- FHO+ basket
- Not in the FHO+ base rate basket (Schedule 2 or 2B).
- Effective date
- Apr 1, 2026
- Termination date
- No end date
Explanation
Updated October 26, 2026
Repeat overnight Level 1 diagnostic sleep study, for a second opinion at another facility or a listed re-evaluation, after a sleep physician's assessment.
What it covers
A repeat diagnostic study is an overnight diagnostic study for a second opinion at a different facility (after assessment by a sleep physician there), or, after a pre-study assessment by a sleep physician, to re-evaluate a negative or inconclusive study, a suspected new co-morbid sleep disorder, or a non-breathing sleep disorder with significant progression or no response to treatment (J110).
A repeat study is not payable if done mainly to adjust positive airway pressure (PAP) treatment (J110 commentary).
Billing rules
- One per patient per facility per 12 months unless prior approval is given (J110).
- Not payable at the same facility that did the initial study within 12 months after it, unless prior approval is given (J110).
- Not payable without the required pre-study assessment by a physician practising sleep medicine (J112).
- Studies for other reasons or over the limits need prior approval from the Ministry (J112).
- Bill the technical component (H) with suffix B and the professional component (P) with suffix C, as separate claims (J107).
- Outside a hospital or a hospital's off-site premises, only the professional component is payable (J107).
- The professional component requires an interpreting physician who meets the CPSO sleep medicine standards, and a qualified physician must be reachable throughout the study (J108).
- Special visit premiums are not payable with sleep studies (J108).
Related codes: J896, J895, J898, J899, J990
Source: Schedule of Benefits (July 1, 2026), Diagnostic and Therapeutic Procedures, Sleep Studies, page J110. Sleep study rules J107–J108, J112.
APEX checks every paid claim against the Schedule of Benefits and flags codes billed below what the visit qualified for. See how APEX works · Pricing