Billing code 95811: Sleep studyMedicare rate & RVUs

Medicare pays $707.77 for 95811 nationally in the office. Local office rates run $616.72–$983.96.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

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.

Where 95811 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

95811 rates by state

Office rate range in each state. Select a state to see its payment localities.

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.

Payment rules and modifiers for 95811

The CMS indicators that decide how 95811 is paid alongside other services.

What modifiers do to the payment

When to use modifier 26

95811 compared with similar codes

How to choose

95810Sleep study

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.

95808Polysomnography

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 study

95807 is an attended study focused on cardiorespiratory measurements rather than sleep staging with multiple additional parameters and PAP titration.

95805Sleep latency test

95805 is a daytime multiple sleep latency test, often performed after an overnight study; it does not represent overnight polysomnography or PAP titration.

Codes related to 95811

Related codes aren’t interchangeable: bill the code that matches the service performed.

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

Open CMS sourceHow we calculate rates