CPT code 95811 refers to a polysomnography exam, a sleep study used to diagnose sleep-related disorders by monitoring brain activity, heart function, muscle activity, eye movements, respiration, and pulse oximetry in a patient over a period of six hours or more.
What Is CPT Code 95811
CPT 95811 refers to a polysomnography exam, a sleep study used to diagnose sleep-related disorders.
The procedure involves monitoring the brain activity, heart function, muscle activity, eye movements, respiration, and pulse oximetry of a six-year-old or older patient over a period of six hours or more.
The patient may be given continuous positive airway pressure (CPAP) therapy during the exam, which a technologist attends to ensure patient comfort and safety.
The exam is typically conducted during the patient’s regular sleep period (usually at night) and records changes in bodily functions at different stages of sleep, including rapid eye movement (REM) and non-rapid eye movement (NREM).
Sleep-related disorders such as sleep apnea, narcolepsy, parasomnia, restless leg syndrome, and periodic limb movements can be identified based on the exam results.
The CPT book describes CPT code 95811 as: “Polysomnography; age six years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist.”
In this procedure, the provider performs a polysomnography exam for a six-year-old or older patient.
The test is done normally during the regular sleep period of the patient at night. The provider monitors the sleep pattern of the patient over a period of six hours or more.
Along with an electroencephalogram (EEG) to monitor brain activity, at least four or more other parameters are monitored, such as electromyography (EMG) to monitor the muscles, electrooculogram (EOG) for the eyes, electrocardiogram (ECG) to monitor the heart, pulse oximetry and respiration, and other parameters.
During the monitoring, the patient is given continuous positive airway pressure (CPAP). A technologist remains in attendance during the study to ensure patient comfort and safety.
The functions monitored include that of the brain (EEG), heart (ECG), muscles (EMG), eyes (EOG), respiration, and pulse oximetry.
The test is done normally during the regular sleep period of the patient, i.e., nighttime. Changes in bodily functions are recorded at different stages of sleep, namely, rapid eye movement (REM) and non–rapid eye movement (NREM).
Sleep-related disorders such as sleep apnea, narcolepsy, parasomnia, restless leg syndrome, or periodic limb movements produce different results in the test.
For example, sleep apnea is evident when there is restricted air intake and reduced blood oxygen level. Similarly, abnormal leg movements during sleep may indicate restless leg syndrome.
How To Use CPT 95811
Polysomnography is performed to diagnose a variety of sleep disorders, including, but not limited to, somnolence, reports of sleeping/napping during the day, falling asleep at work or when driving, and witnessing apneic episodes.
Sleep studies may also be indicated to evaluate a patient’s response to a certain therapy, for example, CPAP, for snoring when overnight oximetry indicates desaturation below 90% greater than 5% of the time.
For a study to be reported as a polysomnogram, sleep must be recorded and staged and must be attended to by a physician and technologist.
Sleep studies should be performed in a hospital, in a sleep laboratory, or by an Independent diagnostic treatment facility supervised by a physician trained in analyzing and interpreting the recordings and should be attended by a trained technologist.
For a sleep study to be considered reasonable and necessary, it must be an observed study. Unattended sleep studies (tests) are not considered a Medicare benefit and will be denied as a noncovered service.