Billing code 95800: Home sleep studyMedicare rate & RVUs in Delaware
Reports an unattended sleep study that records heart rate, oxygen saturation, respiratory data, and sleep time, commonly for evaluation of suspected sleep apnea.
Medicare pays $139.88 for 95800 in the office in Delaware (Delaware). 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.
On this page 9 sections
What 95800 covers
This code describes an unattended sleep study using portable equipment to record heart rate, oxygen saturation, respiratory information, and sleep time during a sleep period. It is commonly used when evaluating a patient for suspected obstructive sleep apnea outside a sleep laboratory. A sleep medicine physician or other qualified interpreting professional reviews the recorded data and prepares the interpretation; equipment and staff support the technical portion of the test.
Select this code when the study includes sleep-time measurement along with the specified physiologic data. The report should identify the study performed and document the recorded data and the interpreting professional’s findings. CMS recognizes professional and technical components: report modifier 26 for interpretation or modifier TC for equipment and staff; without a component modifier, the claim represents the global service. CMS separately prices these modifier components.
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.
95800 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $139.88 | Unavailable |
How the 95800 rate is calculated
Each of 95800’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 · 95800
RVUs × geographic indexes × conversion factor
Work0.83
0.83 RVUs× 1.000 GPCI
Practice expense3.34
3.34 RVUs× 1.000 GPCI
Malpractice0.06
0.06 RVUs× 1.000 GPCI
Adjusted RVUs
4.2300
Conversion factor
$33.4009
Medicare rate
$141.29
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 95800
The CMS indicators that decide how 95800 is paid alongside other services.
CMS payment indicators · 95800
Home sleep study
| 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
95800 without 26 · national office
$141.29
Home sleep study
95800-26 · Professional component
$38.75
Pays only the interpretation and report.
95800 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 95801Sleep study
- Both describe unattended sleep studies with heart rate, oxygen saturation, and respiratory analysis. 95800 includes sleep-time measurement; 95801 does not.
- 95806Sleep study
- 95806 identifies an unattended study that records respiratory effort and airflow. 95800 includes sleep-time measurement and has its own specified data configuration.
- 95807Sleep study
- 95800 is unattended, typically using portable equipment. 95807 describes an attended sleep study.
- 95810Sleep study
- 95810 is attended in-laboratory polysomnography with multiple monitored parameters; 95800 is an unattended study with a more limited specified recording.
95800 billing questions
How does 95800 differ from 95801?
95800 includes sleep-time measurement in addition to heart rate, oxygen saturation, and respiratory analysis. Choose 95801 when the study does not include sleep-time measurement.
How does 95800 differ from 95806?
The codes describe different unattended study data configurations. 95800 includes sleep time, while 95806 identifies a study with respiratory effort and airflow.
When should modifier 26 or TC be used?
Use modifier 26 for the professional interpretation and modifier TC for the equipment and staff portion. Billing without either modifier represents the global service.
What documentation supports reporting 95800?
Document the unattended study performed, the data recorded—including sleep time—and the interpreting professional’s findings.
Is 95800 an attended laboratory study?
No. It describes an unattended study. Code 95807 describes an attended sleep study.
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
Show the CMS file lines behind this rate
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