Summary & Overview
CPT 95805: Multiple Sleep Latency or Maintenance of Wakefulness Testing
CPT code 95805 represents Multiple Sleep Latency or Maintenance of Wakefulness Testing, a critical diagnostic tool in sleep medicine for assessing excessive daytime sleepiness. This procedure is performed in specialized sleep centers and involves repeated trials to measure a patient's propensity to fall asleep, providing valuable insights for diagnosing sleep disorders such as narcolepsy and hypersomnia. Nationally, this code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, ensuring broad coverage for patients requiring advanced sleep evaluation.
This publication offers a comprehensive overview of CPT code 95805, including payer coverage, clinical context, and related billing practices. Readers will gain insight into typical sites of service, common modifiers, associated physician taxonomies, and relevant ICD-10 diagnoses. The report also highlights related CPT codes for sleep studies, providing context for how 95805 fits within the broader landscape of sleep medicine testing. Policy updates and reimbursement benchmarks are discussed to inform stakeholders about current trends and requirements in medical billing for sleep medicine procedures.
CPT Code Overview
CPT code 95805 is used for Multiple Sleep Latency or Maintenance of Wakefulness Testing, a specialized procedure in sleep medicine. This test involves recording, analyzing, and interpreting physiological measurements of sleep during multiple trials to assess a patient's level of sleepiness. The service is typically performed in a Sleep Center setting, designated as Place of Service 99. This procedure is essential for evaluating disorders related to excessive daytime sleepiness and helps guide clinical management in sleep medicine.
Clinical & Coding Specifications
Clinical Context
A patient is referred to a sleep center due to excessive daytime sleepiness and suspected sleep disorders, such as narcolepsy or sleep-related breathing disorders. The patient may have underlying conditions like morbid obesity with alveolar hypoventilation or opioid-induced sleep disorder. The sleep medicine physician orders a multiple sleep latency test (CPT 95805) to objectively assess the patient's level of sleepiness. The procedure involves recording, analyzing, and interpreting physiological measurements during several nap trials throughout the day. The test is performed in a sleep center (Place of Service 99), and results are used to guide further diagnosis and management of sleep disorders.
Coding Specifications
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Modifiers:
26: Professional Component – Used when only the physician's interpretation and report are billed, not the technical portion.TC: Technical Component – Used when only the technical portion (equipment, staff, facility) is billed, not the physician's interpretation.
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Provider Taxonomies:
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