CPT 95811
Global XXX ActivePolysom 6/>yrs cpap 4/> parm
CPT 95811 Billing & Documentation Guide
CPT code 95811 (Polysom 6/>yrs cpap 4/> parm) is classified under Neurology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.54, a non-facility practice expense RVU of 18.37, and a malpractice RVU of 0.28, a total non-facility RVU of 21.19 and facility RVU of 21.19. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $734.92, though rates vary from $616.72 to $983.96 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 95811, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 95811 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 95811 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 95811
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.54 | 2.54 |
| Practice Expense RVU | 18.37 | 18.37 |
| Malpractice RVU | 0.28 | 0.28 |
| Total RVU | 21.19 | 21.19 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 95811
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $818.98 | $818.98 | $763.77 - $983.96 | 29 |
| Florida | $718.66 | $718.66 | $685.47 - $747.22 | 3 |
| Georgia | $681.51 | $681.51 | $643.29 - $719.72 | 2 |
| Illinois | $695.88 | $695.88 | $659.65 - $732.15 | 4 |
| Michigan | $674.15 | $674.15 | $655.59 - $692.71 | 2 |
| North Carolina | $663.28 | $663.28 | $663.28 - $663.28 | 1 |
| New York | $786.08 | $786.08 | $674.31 - $837.18 | 5 |
| Ohio | $654.46 | $654.46 | $654.46 - $654.46 | 1 |
| Pennsylvania | $696.6 | $696.6 | $656.94 - $736.25 | 2 |
| Texas | $698.06 | $698.06 | $651.88 - $742.46 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 95811
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 95811 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0089T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0178T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0179T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0180T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0243T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0244T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0295T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0296T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0297T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0298T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 95811
What does CPT code 95811 mean? +
CPT code 95811 represents: Polysom 6/>yrs cpap 4/> parm. It's in the Neurology category with a global period of XXX.
What is the Medicare reimbursement for CPT 95811? +
The 2026 Medicare national average non-facility payment for CPT 95811 is $734.92. Rates range from $616.72 to $983.96 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 95811? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 95811? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team