$623.73–$665.24
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.
On this page
CMS RVU26D · Effective 2026-10-01
95811 Sleep study Medicare reimbursement rates in Maine
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. Compare 95811 office and facility rates across CMS payment localities in Maine.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 95811 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$655.14–$698.79
2 of 2 localities have a supported rate.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Sleep medicine
About 95811: Attended polysomnography with PAP titration
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.
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.
CMS billing rules for 95811
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
Where the value comes from
- Work RVU2.54 · 12%
- Practice expense (office) RVU18.37 · 87%
- Malpractice RVU0.28 · 1%
194.7K
Medicare services in 2024 · #393 by national volume
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 compared with similar codes
Office rates for Maine, from the same CMS release.
$473.93–$505.86
95808 describes attended polysomnography with fewer additional parameters and applies to any age. 95811 is for age six or older and includes PAP titration.
$409.73–$437.90
95807 is an attended study focused on cardiorespiratory measurements rather than sleep staging with multiple additional parameters and PAP titration.
$442.70–$473.63
95805 is a daytime multiple sleep latency test, often performed after an overnight study; it does not represent overnight polysomnography or PAP titration.
Compare 95811 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
$655.14
Facility
Unavailable
Southern Maine →
Office / nonfacility
$698.79
Facility
Unavailable
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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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
12,54495810,,Polysom 6/> yrs 4/> param,A,,2.44,17.47,,17.47,NA,0.26,20.17,20.17,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,54595810,26,Polysom 6/> yrs 4/> param,A,,2.44,1.03,,1.03,,0.11,3.58,3.58,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,54695810,TC,Polysom 6/> yrs 4/> param,A,,0.00,16.44,,16.44,NA,0.15,16.59,16.59,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,0.00,0.00,0.00
12,54795811,,Polysom 6/>yrs cpap 4/> parm,A,,2.54,18.37,,18.37,NA,0.28,21.19,21.19,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,54895811,26,Polysom 6/>yrs cpap 4/> parm,A,,2.54,1.06,,1.06,,0.11,3.71,3.71,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,54995811,TC,Polysom 6/>yrs cpap 4/> parm,A,,0.00,17.31,,17.31,NA,0.17,17.48,17.48,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,0.00,0.00,0.00
12,55095812,,Eeg 41-60 minutes,A,,1.08,10.30,,10.30,NA,0.09,11.47,11.47,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00