What documentation does 95806 require?

- Indication (Berlin/STOP-BANG positive). - Recording duration at least 4 hours. - AHI, ODI, mean SpO2, time below 90%. - Interpretation and report.

What are common 95806 billing pitfalls?

- If insufficient recording time or quality, study is technically inadequate — payer may deny. - Most payers require pre-authorization.

How much does 95806 pay in 2026?

2026 work RVU for 95806 is 1.05. National Medicare non-facility allowable is approximately $191.72 at the 2026 conversion factor. Adjust for locality GPCI and your payer's contracted conversion factor for actual payment.

Pulmonology · CMS status A

95806

Sleep study, home, unattended

Sleep study, unattended, simultaneous recording of heart rate, oxygen saturation, respiratory analysis, and sleep time.

Pulm

Model in calculator →Audit a note

Work RVU

1.05

2026 Medicare pays

$191.72

National GPCI · non-facility · CF $33.4009

RVU anatomyWork 1.05 + Practice 4.62 + Malpractice 0.07 = 5.74 total

Work (your effort)Practice expenseMalpractice

When to use it

Home sleep apnea test (unattended).

Documentation checklist

✓Indication (Berlin/STOP-BANG positive).
✓Recording duration at least 4 hours.
✓AHI, ODI, mean SpO2, time below 90%.
✓Interpretation and report.

Common pitfalls

!If insufficient recording time or quality, study is technically inadequate — payer may deny.
!Most payers require pre-authorization.

Common modifiers

26TC

Common ICD-10 pairings

G47.33G47.30

Pairs well with

99204

2.60 wRVU

Office o/p new mod 45 min

99214

1.92 wRVU

Office o/p est mod 30 min

Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.