2025 CPT code 95811
(Active) Effective Date: N/A Medicine - Sleep Medicine Feed
Polysomnography, age 6 years or older, with continuous positive airway pressure (CPAP) or bilevel ventilation, attended by a technologist.
Modifiers 26 and 52 are applicable.
Medical necessity must be established for the polysomnography.Documentation should support the presence of a sleep disorder that warrants a sleep study, such as excessive daytime sleepiness, loud snoring, witnessed apneas, or other signs and symptoms suggestive of a sleep-related breathing disorder.The medical record should also document the failure of conservative treatment options, if applicable.
The physician is responsible for ordering and interpreting the polysomnography, evaluating the patient's sleep disorder, and determining the appropriate treatment strategy based on the test results.The technologist is responsible for performing the test, applying the CPAP/BiPAP, monitoring the patient, and ensuring data quality.
In simple words: This is an overnight sleep study where your breathing, heart rate, brain waves, oxygen levels, and other body functions are monitored while you sleep.You will also be given a CPAP or BiPAP machine to help with your breathing during the test. A technician will be there the whole time to make sure everything goes smoothly.
This code represents a comprehensive sleep study conducted on a patient aged 6 or older.It involves continuous monitoring of multiple physiological parameters during sleep, including brain wave activity (EEG), eye movements (EOG), muscle activity (EMG), heart rate and rhythm (ECG), airflow, respiratory effort, and oxygen saturation. The study also includes the initiation and titration of continuous positive airway pressure (CPAP) or bilevel ventilation therapy. A trained technologist is present throughout the study to monitor the patient and ensure data quality.
Example 1: A 7-year-old child with suspected obstructive sleep apnea undergoes polysomnography with CPAP titration to determine the optimal pressure settings for therapy., A 50-year-old adult with excessive daytime sleepiness and snoring undergoes polysomnography with BiPAP titration to diagnose and manage sleep-disordered breathing., A 65-year-old patient with complex sleep apnea and other medical comorbidities undergoes polysomnography with CPAP to assess the effectiveness of CPAP therapy and adjust settings as needed.
Documentation should include a detailed sleep history, physical exam findings, the reason for the study, the type of CPAP/BiPAP used, titration details, sleep staging results, interpretation of the findings, and diagnosis. Any adverse events during the study should also be documented.
- Specialties:Sleep Medicine, Pulmonology, Neurology, Otolaryngology
- Place of Service:Inpatient Hospital, Sleep Lab