Summary & Overview

CPT 95807: Unattended Home Sleep Study with Cardiorespiratory Monitoring

CPT code 95807 represents an unattended sleep study that simultaneously records heart rate, oxygen saturation, respiratory analysis, and sleep time. This code is significant in the national landscape of sleep medicine, as it enables clinicians to assess sleep disorders in a home setting, increasing accessibility and patient comfort. The procedure is commonly used to evaluate conditions such as obstructive sleep apnea and other sleep-related breathing disorders.

Major payers covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides a comprehensive overview of payer coverage, clinical context, and policy updates relevant to this code. Readers will gain insights into typical sites of service, associated clinical indications, and related billing codes. The analysis also highlights common modifiers and taxonomies linked to sleep medicine, offering a clear understanding of how this code fits within broader reimbursement and clinical practice frameworks.

This summary serves as a resource for stakeholders seeking to understand the role of CPT code 95807 in sleep medicine, including its clinical applications, payer coverage, and related coding considerations. The information is organized to support decision-making and policy review at a national level.

AetnaBlue Cross Blue ShieldCigna HealthMedicareUnitedHealthcareCPT 95807Sleep MedicineHome Sleep StudyMedical BillingClinical CodingPolysomnographyRespiratory AnalysisHeart Rate MonitoringOxygen SaturationSleep Disorders

CPT Code Overview

CPT code 95807 is used in sleep medicine to document an unattended sleep study that records heart rate, oxygen saturation, respiratory analysis (such as airflow or peripheral arterial tone), and sleep time. This procedure is typically performed in the patient's home, providing a convenient and accessible option for evaluating sleep-related disorders. The service allows for comprehensive monitoring without the need for in-lab supervision, supporting the diagnosis and management of conditions like sleep apnea and other sleep disturbances.

Clinical & Coding Specifications

Clinical Context

A patient presents with symptoms suggestive of a sleep disorder, such as excessive daytime sleepiness, loud snoring, or observed apneas during sleep. The physician suspects conditions like obstructive sleep apnea or other sleep-related breathing disorders. To evaluate the patient's sleep patterns and respiratory function, an unattended sleep study is ordered. The procedure is performed in the patient's home (Place of Service 12), where a device records heart rate, oxygen saturation, respiratory analysis (e.g., airflow or peripheral arterial tone), and sleep time overnight. The data is later reviewed by a sleep medicine specialist or other qualified physician to assist in diagnosis and management.

Coding Specifications

Modifier 26: Used to indicate the professional component, which covers the physician's interpretation and report of the sleep study.
Modifier TC: Used to indicate the technical component, which covers the provision of equipment and the actual recording of the sleep study data.

Modifier Code	Description
`26`	Professional Component

National Reimbursement Benchmarks

Nationally, the mean rate for CPT code 95807 under Medicare is $308.80, while the average commercial rate (BUCA) is $392.38. This represents a difference of $83.58, with commercial payers generally reimbursing at higher levels than Medicare.

Rate dispersion varies significantly across payers. Cigna exhibits the widest spread, with a difference of $238.00 between its 75th and 25th percentiles, indicating substantial variability in contracted rates. In contrast, Aetna has the tightest range at $107.67, suggesting more consistent reimbursement levels. Blue Cross Blue Shield, UnitedHealth Group, and BUCA also show moderate dispersion, while Medicare's range is $383.00, largely due to its low 25th percentile value.

The table and chart below present a detailed breakdown of national mean rates and percentile benchmarks for each payer.

National Mean Rates for CPT Code `95807` by Payer

Taxonomy Code	Specialty
`207RS0012X`	Sleep Medicine Physician
`207R00000X`	Internal Medicine Physician
`2084P0800X`	Psychiatry & Neurology Physician

Related CPT Codes

95806: Sleep study, unattended, simultaneous recording of heart rate, oxygen saturation, and respiratory airflow.
- Used for similar unattended sleep studies but does not include sleep time measurement.
95810: Polysomnography; sleep staging with 4 or more additional parameters of sleep.
- Used for attended, comprehensive sleep studies in a lab setting, including sleep staging.
95811: Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation.
- Used for attended studies where CPAP or bi-level ventilation is initiated during the study.
94660: Continuous positive airway pressure ventilation (CPAP), initiation and management.
- Used for the initiation and management of CPAP therapy, often following diagnosis from a sleep study.

95806 is an alternative to 95807 when sleep time is not measured. 95810 and 95811 are more comprehensive, attended studies typically performed in a sleep lab. 94660 is commonly used after a sleep study confirms the need for CPAP therapy.

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Summary & Overview

CPT 95807: Unattended Home Sleep Study with Cardiorespiratory Monitoring

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

Related Codes

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

Related Codes