CPT code 95810: Sleep study, age six or older, attended2026 Medicare rate & RVUs in Illinois
Reports an attended overnight diagnostic sleep study for a patient age six or older, using sleep staging and at least four additional physiologic parameters.
Medicare pays $627.82–$696.73 for 95810 in the office in Illinois, from Rest of Illinois to Suburban Chicago, IL. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 95810 covers
This code describes an attended diagnostic polysomnography for a patient age six or older. A sleep technologist monitors the patient during the study, typically in a sleep laboratory, while recording sleep stages and at least four additional physiologic measures. Depending on the study, monitoring may include airflow, respiratory effort, oxygen saturation, heart rhythm, and limb activity. A sleep physician interprets the recorded data and reports the findings, such as evidence of obstructive sleep apnea or another sleep-related disorder.
Select 95810 for a diagnostic study with the required age, attendance, and monitoring scope; it is not the code for a study that includes positive airway pressure titration. Documentation should identify the patient’s age, the attended laboratory setting, the parameters recorded, and the interpretation. The service has professional and technical components: modifier 26 identifies the interpretation, modifier TC identifies equipment and staff, and billing without either modifier represents the global service.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 95810 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$627.82 to $696.73
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $688.43 | Unavailable |
| East St. Louis, IL | $635.82 | Unavailable |
| Rest of Illinois | $627.82 | Unavailable |
| Suburban Chicago, IL | $696.73 | Unavailable |
How the 95810 rate is calculated
Each of 95810’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 95810
RVUs × geographic indexes × conversion factor
Work2.44
2.44 RVUs× 1.000 GPCI
Practice expense17.47
17.47 RVUs× 1.000 GPCI
Malpractice0.26
0.26 RVUs× 1.000 GPCI
Adjusted RVUs
20.1700
Conversion factor
$33.4009
Medicare rate
$673.70
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 95810
The CMS indicators that decide how 95810 is paid alongside other services.
CMS payment indicators · 95810
Sleep study, age six or older, attended
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
95810 without 26 · national office
$673.70
Sleep study, age six or older, attended
95810-26 · Professional component
$119.58
Pays only the interpretation and report.
95810 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 95811Sleep studyPAP titration, age 6+
- Choose 95810 for diagnostic polysomnography; choose 95811 when the study includes positive airway pressure titration.
- 95808PolysomnographySleep staging, 1–3 parameters
- 95808 is the attended polysomnography code for any age with a different number of additional parameters. 95810 is for patients age six or older with the broader parameter scope.
- 95807Sleep studyTechnologist-attended recording
- 95807 covers attended respiratory-focused sleep monitoring without the sleep-staging scope of 95810.
- 95806Sleep studyHeart rate and respiratory signals
- 95806 is an unattended respiratory sleep study. 95810 is performed with a technologist and includes sleep staging.
95810 billing questions
When should 95810 be used instead of 95811?
Use 95810 for the attended diagnostic study. Use 95811 when the study includes positive airway pressure titration.
Can the interpretation be billed separately from the sleep laboratory service?
Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service, including equipment and staff. Without either modifier, the claim represents the global service.
What documentation supports 95810?
The record should support the patient’s age, technologist attendance, sleep staging, the additional physiologic parameters recorded, and the physician’s interpretation.
How does 95810 differ from 95807?
95810 includes sleep staging and at least four additional parameters for a patient age six or older. 95807 describes an attended sleep study focused on respiratory and related monitoring, without the same sleep-staging scope.
Is an unattended home study reported as 95810?
No. 95810 describes an attended study with a technologist. Code 95806 is an unattended sleep study focused on respiratory monitoring.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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