CPT 95800, 95801 and 95806, the home sleep test codes, are deleted effective 1 January 2027. The AASM announced on 15 July 2026 that six new unattended sleep-testing codes replace them, split into technical and professional services. CMS valued them, as proposed, in the CY2027 PFS proposed rule (CMS, 14 July 2026 fact sheet; Federal Register 2026-14327).
The three current codes stay billable for dates of service through 31 December 2026. From 1 January, every home sleep test your practice or sleep center bills moves to the new structure, which changes both the code you pick and who bills which component. This guide covers what the new codes are, a checklist to work through before January, the Medicare coverage rules that do not change, and the coding details that deny most sleep claims today.
What changes on 1 January 2027
According to the AASM’s 15 July 2026 announcement, the revised structure replaces 95800, 95801 and 95806 with six new codes that better reflect the complexity of the study, and it separates technical services from professional interpretation. The AASM developed the codes with the American Academy of Neurology, the American College of Chest Physicians and the American Thoracic Society, and the AMA CPT Editorial Panel approved them.
The CY2027 PFS proposed rule (CMS, 14 July 2026 fact sheet; Federal Register 2026-14327, published 16 July 2026, beginning at 91 FR 43888) describes the family in more detail:
- Three technical codes cover set-up, data acquisition and technical analysis, at low, moderate and high complexity.
- Three professional codes cover interpretation and report by a physician or other qualified health care professional, at the same three complexity levels.
- Complexity is defined by the number of recording channels and the parameter categories they generate. The number of channels your device records drives code selection.
On payment, CMS proposes to accept the RUC-recommended values for five of the six codes and a lower work value for the high-complexity interpretation code (AASM, 15 July 2026; 91 FR 43888). CMS also asked for comment on the equipment time the RUC assumed for home devices. These values stay proposed until the final rule publishes, and payers set their own rates. The comment period closed on 14 September 2026.
When you load the six codes, take the numbers and descriptors from the AMA’s CPT 2027 code set, not from the placeholder numbers used in rulemaking documents.
What does not change: attended in-lab polysomnography, 95810 and 95811, is not part of this replacement (AASM, 15 July 2026).
Readiness checklist before January
Work through this list in October and November, while there is still time to fix what it turns up.
- Fee schedule load. Add the six new codes to your fee schedule and payer contract files, then update them again when final Medicare values publish.
- Charge master. Retire 95800, 95801 and 95806 for dates of service on or after 1 January 2027, and map each home sleep test to one technical code and one professional code.
- Device-to-code mapping. Record how many channels each home testing device you use actually captures. Complexity tiers are defined by channels and parameter categories (91 FR 43888), so the device determines the tier.
- EHR order sets. Update home sleep test order sets so each study documents the channels and parameters the tier depends on.
- Split billing between entities. Decide who bills each component when the device supplier, sleep lab and interpreting physician are separate, and set up separate claim workflows.
- Prior-authorization templates. Rebuild authorization requests around the new codes, and check whether authorizations issued in 2026 for studies performed in 2027 must be reissued.
- Payer policy watch. Track Medicare contractor articles and commercial policies for the new codes. Some insurers accept the HCPCS home sleep test codes G0398, G0399 and G0400 instead of the CPT codes, and the AASM advises checking with each insurer which codes it accepts.
- Staff training. Train schedulers, coders and interpreting physicians on code selection and documentation.
- First-claim audit. Audit the first January claims billed with the new codes and fix errors before they repeat.
Coding sleep studies through 31 December 2026
Until the deletion date, use the current codes as the AASM code list describes them:
- 95800: unattended sleep study recording heart rate, oxygen saturation, respiratory analysis (for example by airflow or peripheral arterial tone) and sleep time.
- 95801: unattended sleep study recording at minimum heart rate, oxygen saturation and respiratory analysis.
- 95806: unattended sleep study recording heart rate, oxygen saturation, respiratory airflow and respiratory effort.
- 95810: attended polysomnography, age 6 or older, sleep staging with 4 or more additional parameters. AAPC’s summary describes polysomnography as six or more hours of recording with physician review, interpretation and report.
- 95811: the same attended study with initiation of CPAP or bilevel ventilation.
- 95805: multiple sleep latency or maintenance of wakefulness testing, which the descriptor defines as testing during multiple trials. Report it once for the series, not once per nap.
When only one component is billed, the AASM code list notes that modifier TC reports the technical component and modifier 26 the professional component.
Split-night studies. Palmetto GBA’s LCD L36593 accepts a split-night study (a diagnostic polysomnogram confirming OSA followed by CPAP titration on the same night) in place of two separate nights, as long as titration runs for more than 3 hours and the study shows CPAP eliminates or nearly eliminates respiratory events. Because the 95811 descriptor on the AASM code list already covers polysomnography with initiation of CPAP, the split night is one 95811 study, not 95810 plus 95811.
Medicare coverage for the sleep test itself
Which tests count. NCD 240.4.1 covers Type I attended polysomnography in a sleep lab; Type II or Type III devices attended in a lab or unattended in or out of a lab; Type IV devices measuring three or more channels, one of which is airflow; and devices measuring three or more channels that include actigraphy, oximetry and peripheral arterial tone. Each requires clinical signs and symptoms indicative of OSA.
Symptoms in the record. Local policy adds detail. WPS’s LCD L36839 states diagnostic testing is covered only if the patient has the symptoms or complaints of one of the conditions the LCD lists, so the chart has to name them.
Repeat testing. Palmetto’s L36593 states that generally one night is adequate to document sleep apnea. A repeat study needs documentation of why: a technically inadequate first study, insufficient sleep, inconclusive results, or the need to start or confirm therapy.
Accreditation. Palmetto’s L36593 and billing article A55958 require a sleep center billing the technical component of polysomnography or home sleep testing to keep documentation of accreditation by the AASM, the Accreditation Commission for Health Care, or the Joint Commission’s Ambulatory Care Accreditation Program. The LCD carves out one exception: an office-based physician who meets its training and certification requirements may bill a home sleep test globally. Commercial payers often set their own standards; check each contract.
CPAP coverage: what NCD 240.4 actually requires
Most sleep claims exist to support a treatment decision, so the CPAP rules decide whether the test was worth billing. NCD 240.4 (CMS Pub. 100-03, effective 13 March 2008) sets the national rule:
- Diagnosis. A positive OSA diagnosis must include a clinical evaluation and a positive attended polysomnogram in a sleep laboratory, or an unattended home sleep test with a Type II device, a Type III device, or a Type IV device that measures at least 3 channels.
- Order. The treating physician must have ordered the sleep test, and it must be furnished under appropriate physician supervision.
- Severity. An initial 12-week period of CPAP is covered in adult patients with OSA when the AHI or RDI is 15 or more events per hour, or 5 to 14 events per hour with documented excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease or history of stroke.
- Education. The CPAP provider must educate the beneficiary on proper use of the device before use.
The DME MACs’ LCD L33718 (revision effective 1 January 2024) adds the detail that drives denials:
- The clinical evaluation must be in person. The beneficiary needs an in-person clinical evaluation by the treating practitioner before the sleep test to assess for OSA. A note written after the study does not meet this.
- Minimum event counts. The LCD requires at least 30 events at the 15-per-hour threshold, and at least 10 events at the 5-to-14 threshold.
- Continued coverage after three months. Between the 31st and 91st day after starting therapy, the treating practitioner must do an in-person re-evaluation documenting that symptoms improved, and review objective adherence: PAP use of 4 or more hours per night on 70% of nights during a consecutive 30-day period in the first three months.
If the pre-test evaluation or the adherence data is missing, the DME claim fails even when the sleep study was coded perfectly.
ICD-10-CM coding for sleep apnea
AAPC’s listing for category G47.3 gives the codes you will use most:
- G47.33 Obstructive sleep apnea (adult) (pediatric), the primary diagnosis for OSA.
- G47.31 Primary central sleep apnea.
- G47.39 Other sleep apnea.
- G47.30 Sleep apnea, unspecified. Replace it with a specific code once the diagnosis is made.
The category carries a “code also any associated underlying condition” note, so report a documented comorbidity such as obesity alongside G47.33. It also carries Excludes1 notes: do not report G47.3 codes with apnea NOS (R06.81), Cheyne-Stokes breathing (R06.3), pickwickian syndrome (E66.2), or sleep apnea of newborn (subcategory P28.3-).
Oral appliance therapy is billed to medical insurance
A custom oral appliance for OSA is a medical DME item, not a dental service. Per the AASM code list, E0486 describes a custom-fabricated oral appliance and includes fitting and adjustment, so those services are not billed separately. Under the DME MACs’ LCD L33611, Medicare covers E0486 only when:
- the beneficiary had an in-person clinical evaluation by the treating practitioner before the sleep test;
- a Medicare-covered sleep test meets the LCD’s AHI or RDI thresholds;
- the treating practitioner orders the device after reviewing the sleep test report;
- the device is provided and billed by a licensed dentist (DDS or DMD).
A prefabricated appliance, E0485, is denied as not reasonable and necessary under the same LCD. CDT codes can document the dental work internally, but the Medicare claim for the appliance goes to the DME MAC with E0486.
Documentation that holds up
Most sleep denials trace to the record, not the code. Before a claim goes out, check that the chart holds:
- the pre-test in-person evaluation, including symptoms that match the LCD’s covered conditions;
- the physician order for the study;
- the full study report and interpretation, with the device type and channels recorded;
- prior authorization, where the plan requires it;
- for CPAP, the adherence download and the re-evaluation note, dated within the LCD’s window.
When a claim does deny, read the remittance reason code first. A registration error or a transposed policy number is a corrected claim. A medical-necessity denial is an appeal, built on the chart and the payer’s written policy. Follow each payer’s appeal process and deadlines.
Get the transition right the first time
AMS Solutions has billed for physician practices since 1992. Our AAPC-certified coders work sleep and neurology claims every day, from home sleep tests and in-lab studies to the CPAP documentation window. See how we handle polysomnography billing and coding for CPT 95810 and 95811, browse coding references in our resources library, or talk to us about neurology billing services before your first January claims go out.
