CPT code 95811 plays a key role in billing sleep studies correctly in 2025. With tighter payer rules and more audits, coding mistakes can lead to denials. This article helps you understand when to use CPT 95811, what documentation is required, and how to stay compliant with Medicare and private insurers.
What CPT 95811 Covers
CPT 95811 applies when a sleep study includes:
- Sleep staging (brain wave activity)
- Four or more additional measurements (like airflow and oxygen)
- Start of CPAP or BiPAP therapy during the night
- In-person monitoring by a technologist
This service is often called a split-night study. It begins as a diagnostic test. If sleep apnea is found, the provider starts CPAP therapy during the same night. You should not bill extra codes for EEG, EMG, or CPAP setup—those are already included.
95811 vs. 95810: What’s the Difference?
Many providers mix up these two codes. However, it’s easy to get it right:
- Use 95811 when CPAP or BiPAP therapy starts during the sleep study.
- Use 95810 if the test only collects diagnostic data, with no therapy involved.
For example, if the technologist starts CPAP during the night, report 95811 only. If CPAP wasn’t started—due to low AHI, patient refusal, or short test time—report 95810 instead.
2025 Medicare and Insurance Rules
In 2025, CMS and other payers require clean reporting. Medicare states that 95811 includes both diagnostic and therapeutic parts of a split-night study. Therefore, reporting 95810 and 95811 together is incorrect. Use only 95811 if therapy begins during the test.
According to CMS.gov and UnitedHealthcare, you should not bill 94660 (CPAP setup) with 95811. That service is already built into the code. Likewise, avoid reporting EEG or EMG separately. They are part of the polysomnography package.
Approved ICD-10 Codes for CPT 95811
Here are the most common diagnosis codes that support the use of 95811:
- G47.33 – Obstructive sleep apnea
- G47.31 – Central sleep apnea
- G47.30 – Sleep apnea, unspecified
- G47.10 – Hypersomnia, unspecified
Make sure the medical record and sleep study report clearly show why the test was needed. Also, the documentation should match the ICD-10 codes submitted on the claim.
Tips for Documentation and Modifiers
Clear documentation makes your claim stronger. To avoid denials, follow these steps:
- Record the exact time CPAP or BiPAP was started.
- Note the total sleep time and parameters recorded.
- Confirm the technologist was present during the full study.
- Use modifier -52 if the test was cut short (less than 6 hours).
Additionally, avoid vague terms like “partial night.” Instead, describe what happened and why therapy started—or didn’t.
Avoid These Billing Errors
Incorrect billing causes delays and rejections. Be sure to avoid the following:
- Billing 95810 and 95811 together
- Adding 94660 with 95811 (CPAP is already included)
- Reporting EEG or EMG codes with 95811
- Using unsupported or missing diagnosis codes
Most denials come from misunderstanding bundling rules or failing to meet medical necessity. Always check your payer’s policy before filing.
Frequently Asked Questions
Can I bill 95811 and 95810 on the same date?
No. If therapy begins during the night, report 95811 only. It includes both parts of a split-night study.
Is CPAP setup covered under 95811?
Yes. The initiation of CPAP or BiPAP therapy is part of CPT 95811. You should not bill 94660 separately.
What diagnosis codes justify 95811?
Codes like G47.33 (obstructive sleep apnea) or G47.31 (central sleep apnea) are most common. Check your payer’s LCD or coverage policy for accepted codes.
Conclusion
Coding 95811 correctly helps you avoid rework, get paid faster, and stay compliant. In 2025, follow these steps to ensure success:
- Use 95811 when CPAP or BiPAP starts during the sleep study.
- Don’t add 95810, 94660, or EEG codes to the same claim.
- Match your diagnosis codes to the documentation and sleep study findings.
- Stay current with CMS and payer rules on bundling and medical necessity.
Need more help? Check out these related resources:
For official updates, visit CMS.gov, AMA, and AAPC.com. Staying informed protects your revenue and keeps your coding sharp.