CPT code 95811: Sleep study, PAP titration, age 6+2026 Medicare rate & RVUs in Guam
Reports an attended overnight sleep study for a patient age six or older that includes sleep staging, multiple physiologic measurements, and CPAP or bilevel titration.
Medicare pays $787.89 for 95811 in the office in Guam (Hawaii, Guam, HI). 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 95811 covers
This attended overnight study records sleep stages and at least four additional physiologic parameters while a sleep technologist monitors the patient. It includes starting and adjusting continuous positive airway pressure or bilevel ventilation during the study to assess treatment. Sleep laboratories commonly perform it for suspected obstructive sleep apnea when pressure needs to be established, or as a split-night study when diagnostic findings lead to titration during the same night. A sleep physician or other qualified interpreting professional reviews the recorded data and reports the findings and titration results.
Report 95811 for a patient age six or older when the study includes the required monitoring and PAP titration; a diagnostic-only study without titration is distinguished by 95810. For a split-night study, report the combined diagnostic and titration service rather than separately reporting 95810 for the diagnostic portion. Documentation should identify the monitored parameters, technologist attendance, titration performed, and interpretation. CMS prices the professional interpretation with modifier 26 and the equipment and staff portion with modifier TC; reporting the code 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.
95811 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | $787.89 | Unavailable |
How the 95811 rate is calculated
Each of 95811’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 · 95811
RVUs × geographic indexes × conversion factor
Work2.54
2.54 RVUs× 1.000 GPCI
Practice expense18.37
18.37 RVUs× 1.000 GPCI
Malpractice0.28
0.28 RVUs× 1.000 GPCI
Adjusted RVUs
21.1900
Conversion factor
$33.4009
Medicare rate
$707.77
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 95811
The CMS indicators that decide how 95811 is paid alongside other services.
CMS payment indicators · 95811
Sleep study, PAP titration, age 6+
| 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
95811 without 26 · national office
$707.77
Sleep study, PAP titration, age 6+
95811-26 · Professional component
$123.92
Pays only the interpretation and report.
95811 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 95810Sleep studyAge six or older, attended
- Both describe attended polysomnography for patients age six or older. Choose 95811 when CPAP or bilevel titration is performed; choose 95810 for diagnostic testing without titration.
- 95808PolysomnographySleep staging, 1–3 parameters
- 95808 describes attended polysomnography with fewer additional parameters and applies to any age. 95811 is for age six or older and includes PAP titration.
- 95807Sleep studyTechnologist-attended recording
- 95807 is an attended study focused on cardiorespiratory measurements rather than sleep staging with multiple additional parameters and PAP titration.
- 95805Sleep latency testDaytime nap testing
- 95805 is a daytime multiple sleep latency test, often performed after an overnight study; it does not represent overnight polysomnography or PAP titration.
95811 billing questions
When should 95811 be chosen instead of 95810?
Use 95811 when an attended study for a patient age six or older includes CPAP or bilevel titration. Use 95810 for an attended diagnostic study without PAP titration.
Can 95810 also be reported for the diagnostic portion of a split-night study?
No. Report 95811 for the combined diagnostic and titration service rather than separately reporting 95810 for the initial portion of that same split-night study.
How do modifiers 26 and TC apply?
Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service, including equipment and staff. Without either modifier, 95811 represents the global service.
What documentation supports 95811?
Document the patient's age, technologist attendance, sleep staging and additional parameters monitored, PAP titration performed, and the interpreting professional's findings.
Can a multiple sleep latency test be reported with 95811?
A multiple sleep latency test may be performed after an overnight sleep study as a separate daytime service when clinically indicated. The records should distinguish the daytime test from the overnight study and its titration.
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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