2025 CPT code 95806
(Active) Effective Date: N/A Revision Date: N/A Diagnostic - Sleep Medicine Testing Procedures Medicine Services and Procedures > Neurology and Neuromuscular Procedures > Sleep Medicine Testing Procedures Feed
Unattended sleep study recording heart rate, oxygen saturation, respiratory airflow, and respiratory effort.
Modifier 26 (professional component) and modifier 52 (reduced services) may be applicable.The use of modifier TC (technical component) may depend on the provider's role and the setting of service.
Medical necessity for an unattended sleep study (95806) is established when clinical findings suggest a sleep disorder that requires diagnostic testing.This could include symptoms like excessive daytime sleepiness, snoring, witnessed apneas, or other indicators of sleep-disordered breathing.Specific criteria might vary depending on payer guidelines.
A physician or other qualified healthcare professional is responsible for interpreting the results of the unattended sleep study and generating a report for diagnosis and treatment planning of sleep disorders.The clinical responsibility also includes medical necessity determination for the study.
- Medicine Services and Procedures > Neurology and Neuromuscular Procedures > Sleep Medicine Testing Procedures
- Sleep Medicine Testing Procedures
In simple words: This test measures your heart rate, oxygen levels, breathing, and chest/belly movements while you sleep without a technician present.This helps doctors diagnose sleep disorders.
This CPT code represents an unattended sleep study involving the simultaneous recording of various physiological parameters while the patient sleeps.These parameters include heart rate, oxygen saturation (SpO2), respiratory airflow (ventilation), and respiratory effort (e.g., thoracoabdominal movement). The study is conducted without a technologist physically present.The recording, interpretation, and report are included in the code.Modifier 52 should be appended if less than 6 hours of recording is obtained.
Example 1: A patient presents with complaints of excessive daytime sleepiness and snoring. An unattended sleep study (95806) is ordered to evaluate for obstructive sleep apnea (OSA). The results show an elevated apnea-hypopnea index (AHI), confirming the diagnosis of OSA., A patient with suspected central sleep apnea undergoes an unattended home sleep study (95806). The data collected helps in the differentiation between central and obstructive sleep apnea, guiding the selection of appropriate treatment strategies., A patient with periodic limb movement disorder (PLMD) is evaluated with an unattended sleep study (95806) to assess the frequency and severity of leg movements during sleep. This helps in planning intervention.
* Patient's history and physical examination findings related to sleep complaints.* Detailed sleep study report including all recorded parameters (heart rate, oxygen saturation, respiratory airflow, respiratory effort).* Physician's interpretation and diagnosis based on the sleep study results.* Documentation supporting medical necessity for the sleep study.
** Payers may have specific requirements for documentation and medical necessity.Always refer to the payer's guidelines for accurate reimbursement.
- Revenue Code: T2D (OTHER TESTS - OTHER)
- RVU: Refer to the CMS Physician Fee Schedule for the most up-to-date RVU values and reimbursement rates.These values vary by geographic location and other factors.
- Payment Status: Active (as of 03 December 2024)
- Modifier TC rule: Modifier TC may be appended if billing for only the technical component of the service; however, this is dependent on the provider and facility arrangement.It is not appended when billing for the global service.
- Fee Schedule : Refer to the CMS Physician Fee Schedule and historical data for changes in payment rates over time.
- Specialties:Sleep Medicine, Pulmonology, Neurology
- Place of Service:Home, Office, Sleep Clinic, Hospital (Inpatient or Outpatient)