Billing and Coding: Polysomnography and Other Sleep Studies

Facility-based polysomnography (CPT 95808/95810/95811) is covered when performed in a facility sleep laboratory, while home sleep testing (G0398–G0400) is covered only when done with a Medicare‑approved device in conjunction with a comprehensive sleep evaluation for patients with high pretest probability of moderate to severe OSA. Documentation requirements include provider instruction for HST, detailed recording of sleep and respiratory parameters, physician referral/order, and justification for more than expected testing frequency; routine excess testing (e.g., >1 HST/year, >2 PSG/year, or >1 PSG for CPAP titration) requires persuasive medical necessity and may be subject to review.

"Facility-based polysomnography (CPT 95808, 95810, 95811) is covered when performed in a facility-based sleep laboratory (not in the home or a mobile facility)."

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