CPT 95805: Polysomnography Sleepiness and Wakefulness Assessment
Medicare pays $334 and commercial payers pay $1228 on average nationally for this procedure.
CPT code 95805 describes an attended laboratory polysomnography study in which the provider measures a patient’s sleepiness and wakefulness while monitoring physiological parameters during sleep; service type: diagnostic sleep study (polysomnography); typical site of service: sleep laboratory / inpatient sleep center, attended by technologist or clinical staff during an overnight or extended sleep recording.
For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.
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National Reimbursement Benchmarks
Medicare’s mean rate of $334.10 sits below BUCA’s average commercial mean of $1,227.70, indicating that commercial BUCA reimbursement for CPT 95805 is substantially higher than the Medicare average. That gap highlights how commercial networks can pay multiples of Medicare for this service; Medicare’s distribution also shows notable spread across 47 localities with a P25 of $60.50 and a P75 of $481.50.
Examining P75 minus P25 as a simple dispersion metric, Blue Cross Blue Shield has the tightest interquartile spread at $480.90 (P75 $1,971.20 minus P25 $1,491.30), while UnitedHealth Group shows a wide spread of $502.90 (P75 $645.10 minus P25 $146.20). Cigna’s IQR is $609.30, Aetna’s is $335.30, and BUCA’s is $506.00; Medicare’s IQR is $421.00. These differences reflect varying regional and contractual variability across payers.