Does 95803 require prior authorization?

No, 95803 does not require prior authorization (low confidence). No active coverage policies found for this code.

What is the Medicare reimbursement rate for 95803?

Medicare facility rate: $135.27. Non-facility rate: $135.27. Work RVU: 0.88.

HCPCS/CPT

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Work RVU

0.88

Facility

$135.27

Non-Facility

$135.27

If a sleep study is performed for less than six hours, bill with modifier 52 and report the appropriately reduced original charge.
Medical records must document the signs, symptoms, or complaints demonstrating the indication for sleep testing; if the patient is admitted, documentation must explicitly support inpatient admission and indications.
Persuasive medical evidence of medical necessity must be provided when additional tests beyond usual limits (e.g., >1 HST/year, >2 PSG/year, >3 MSLT naps) are claimed.
MSLT (CPT 95805) includes all naps done in a single day; only one unit of CPT 95805 should be submitted for that day's MSLT.

Diagnostic polysomnography or other sleep testing is covered when the patient has symptoms or complaints of one of the conditions listed in LCD L36839.
A single polysomnogram (PSG) with EEG is ordinarily sufficient and covered to evaluate and diagnose suspected obstructive sleep apnea (OSA).
Diagnosis of narcolepsy is ordinarily confirmed by up to three Multiple Sleep Latency Test (MSLT) naps; MSLT (CPT 95805) performed appropriately is covered for this indication.
Polysomnography (CPT 95808, 95810, 95811) is covered when performed in a facility-based sleep study laboratory (not in the home or a mobile facility).
Home sleep testing (HST) (HCPCS G0398, G0399, G0400) is covered when performed as part of a comprehensive sleep evaluation in patients with a high pretest probability of moderate to severe obstructive sleep apnea.
Testing for narcolepsy (e.g., MSLT) is indicated when the sleep disorder clinic documents that narcolepsy symptoms are severe enough to interfere with the patient’s well-being and health.

L38528 — Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

J05

A56903 — Billing and Coding: Polysomnography and Other Sleep Studies

J05

L36839 — Polysomnography and Other Sleep Studies

J05

CGS-L36902 — Polysomnography and Other Sleep Studies

J18 MAC Part B

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