Billing code 95805: Sleep latency testMedicare rate & RVUs in Texas
Reports daytime nap testing that measures sleep propensity, commonly used to evaluate persistent excessive sleepiness and suspected narcolepsy after overnight sleep assessment.
Medicare pays $440.09–$504.29 for 95805 in the office in Texas, from Beaumont to Austin. 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 95805 covers
A multiple sleep latency test uses repeated, scheduled daytime nap opportunities to assess how readily a patient falls asleep and whether sleep-onset features support a central hypersomnolence disorder such as narcolepsy. A sleep technologist typically conducts the recording in a sleep laboratory, and a qualified interpreting professional reviews the results and prepares the report. The test commonly follows an overnight attended polysomnography as part of an evaluation for persistent excessive daytime sleepiness.
Report 95805 for the daytime test, not for the preceding overnight study or for each nap opportunity separately. The record should support the clinical reason for testing and include the test findings and interpretation. CMS recognizes a professional component, reported with modifier 26, and a technical component, reported with modifier TC; reporting the code without a modifier represents the global service, including both components. CMS separately prices the 26 and TC services.
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 95805 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$440.09 to $504.29
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $504.29 | Unavailable |
| Beaumont | $440.09 | Unavailable |
| Brazoria | $474.79 | Unavailable |
| Dallas | $477.44 | Unavailable |
| Fort Worth | $473.17 | Unavailable |
| Galveston | $475.93 | Unavailable |
| Houston | $479.04 | Unavailable |
| Rest Of Texas | $456.91 | Unavailable |
How the 95805 rate is calculated
Each of 95805’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 · 95805
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.17Practice expense 13.02Malpractice 0.17
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 95805
The CMS indicators that decide how 95805 is paid alongside other services.
CMS payment indicators · 95805
Sleep latency test
| 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
95805 without 26 · national office
$479.64
Sleep latency test
95805-26 · Professional component
$57.78
Pays only the interpretation and report.
95805 compared with similar codes
Compare codes
95805 vs 95810 vs 95811 vs 95803: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 95810Sleep study
- 95810 is an attended overnight polysomnography. 95805 is daytime nap testing, often performed after the overnight study.
- 95811Sleep study
- 95811 is an attended polysomnography with positive airway pressure titration; 95805 measures daytime sleep propensity rather than titrating breathing treatment.
- 95803Actigraphy testing
- 95803 is actigraphy testing. It records sleep-wake patterns over time, whereas 95805 uses scheduled daytime nap opportunities to assess sleep propensity.
95805 billing questions
When is 95805 appropriate instead of an overnight sleep study?
Use 95805 for daytime nap testing of sleep propensity, often when evaluating persistent excessive sleepiness or suspected narcolepsy. An overnight polysomnography evaluates sleep during the night and may precede the MSLT.
Can the preceding polysomnography also be reported?
The overnight study and the daytime MSLT are distinct services. When both are performed, report the appropriate code for each documented test.
How are the professional and technical components reported?
Report modifier 26 for the professional interpretation and modifier TC for the technical service. Without either modifier, 95805 represents the global service.
Should a unit be reported for each nap opportunity?
No. Report the MSLT as the test service rather than billing each scheduled nap opportunity as a separate unit.
What documentation supports 95805?
Document the clinical indication for daytime sleepiness testing, the nap-test findings, and the interpreting professional's report. The record should distinguish the daytime MSLT from any overnight 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
Fee sheets
Put 95805 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →