CPT 95811: Attended Polysomnography, ≥6 Hours
Medicare pays $492 and commercial payers pay $1393 on average nationally for this procedure.
CPT code 95811 describes an attended polysomnography study in which the physician monitors the patient’s sleep patterns and multiple physiologic parameters continuously for a period of six hours or more; the service is a comprehensive sleep study (polysomnography) typically provided in an accredited sleep laboratory or attended sleep center and is used to evaluate sleep-disordered breathing and other sleep-related conditions.
For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.
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National Reimbursement Benchmarks
National comparisons show that Medicare’s mean rate of $492.4 sits below the BUCA average commercial mean of $1392.6, highlighting a substantial gap between Medicare reimbursement and the broader commercial benchmark. Blue Cross Blue Shield and UnitedHealth Group both have mean rates ($1947.8 and $694.2, respectively) that sit above Medicare, while Aetna ($528.5) and Cigna ($734.5) are closer to Medicare’s level but still generally higher.
Rate dispersion (P75 minus P25) varies meaningfully: Blue Cross Blue Shield has the widest interquartile spread at $600.0 (P75 $2147.4 minus P25 $1547.5), indicating high variability in commercial contracting, followed by UnitedHealth Group with a spread of $640.1 (P75 $970.1 minus P25 $309.0). The tightest spreads are seen with Aetna at $484.8 (P75 $720.8 minus P25 $213.6) and Cigna at $816.0 (P75 $1105.4 minus P25 $291.3) — note that while Cigna’s spread is larger than Aetna’s, it reflects different center points in their distributions.