How much does Medicare pay for CPT 95800?

Medicare allowed an average of $117.17 per service and paid $88.17 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $447.29, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 95800?

Sleep study including heart rate, breathing, and sleep time. It was billed 168,037 times to 154,121 Medicare beneficiaries by 1,583 providers in 2024.

Does 95800 pay differently in an office than a hospital?

Yes. The allowed amount averaged $125.98 in an office setting and $38.83 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 95800 most?

Independent Diagnostic Testing Facility (IDTF), with 62,721 services from 73 clinicians. Next are Pulmonary Disease, Sleep Medicine, Neurology.

CPT 95800

Sleep study including heart rate, breathing, and sleep time

$117.17Medicare-allowed amount per service, averaged across 168,037 services

Providers submitted

$447.29

Asking price, not received

Medicare allowed

$117.17

The fee schedule figure

Medicare paid

$88.17

Balance is patient coinsurance

Providers submitted an average of $447.29 for this code and Medicare allowed $117.17 — 3.8× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $88.17 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $125.98
Hospital / facility: $38.83

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 151,050 services were billed in an office setting and 16,987 in a facility.

Services: 168,037
Beneficiaries: 154,121
Providers billing it: 1,583
Total allowed: $19,688,895

What Medicare pays for CPT 95800

Across 168,037 services billed by 1,583 providers to 154,121 beneficiaries, Medicare allowed an average of $117.17 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 95800

Specialty	Services	Beneficiaries	Avg allowed	Providers
Independent Diagnostic Testing Facility (IDTF)	62,721	59,415	$147.93	73
Pulmonary Disease	40,146	36,538	$96.44	559
Sleep Medicine	20,084	18,499	$84.61	250
Neurology	11,945	10,986	$97.01	184
Internal Medicine	7,458	6,261	$104.13	145
Otolaryngology	5,925	5,293	$102.80	100
Critical Care (Intensivists)	5,894	5,235	$93.66	76
Psychiatry	5,473	4,717	$139.59	15
Cardiology	3,159	2,883	$120.58	72
Family Practice	1,530	1,442	$87.13	33
Allergy/ Immunology	1,092	571	$161.17	4
Interventional Cardiology	541	467	$119.71	18
Nurse Practitioner	362	343	$104.00	13
Hospitalist	278	272	$130.34	3
Undefined Physician type	259	257	$132.54	2

95800 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	25,557	$157.82	$95.04	100
Maryland	24,856	$147.07	$95.93	63
California	22,644	$138.40	$83.88	127
Texas	16,761	$105.17	$83.10	203
New York	8,155	$104.56	$70.77	106
Massachusetts	7,045	$96.90	$66.53	55
New Jersey	6,794	$85.60	$59.18	93
Pennsylvania	5,674	$85.92	$64.37	71
Georgia	5,615	$83.86	$67.33	93
Illinois	5,229	$62.18	$46.96	87
Arizona	4,370	$113.63	$89.16	57
Virginia	3,783	$112.86	$83.72	49
Colorado	3,501	$97.82	$72.34	32
Iowa	1,954	$84.30	$66.30	19
Wisconsin	1,844	$55.76	$40.37	25
Missouri	1,765	$95.60	$72.29	14
Michigan	1,733	$82.86	$64.96	28
Nevada	1,521	$130.68	$101.67	19
South Carolina	1,356	$72.40	$55.56	21
Delaware	1,294	$116.44	$88.50	14
Louisiana	1,280	$89.18	$74.39	29
Indiana	1,241	$49.29	$37.79	26
Oregon	1,225	$94.05	$66.01	27
North Carolina	1,102	$87.69	$71.05	26
Kansas	1,066	$74.06	$58.29	16
Mississippi	995	$100.17	$87.91	14
Oklahoma	934	$102.94	$86.04	11
Nebraska	878	$86.41	$67.91	8
Washington	860	$59.51	$40.45	18
Tennessee	824	$87.85	$70.11	16
Rhode Island	698	$116.53	$82.08	3
Ohio	687	$72.73	$58.55	14
Connecticut	650	$120.22	$84.14	19
Minnesota	598	$87.39	$63.82	18
Maine	570	$41.31	$33.08	7
Alaska	467	$118.05	$77.13	4
Utah	418	$62.53	$49.74	10
New Mexico	389	$109.68	$89.58	4
District of Columbia	337	$117.92	$77.03	7
Arkansas	247	$57.14	$46.20	6
Hawaii	241	$71.70	$51.37	3
Alabama	185	$60.15	$51.55	3
New Hampshire	182	$117.98	$93.25	2
Idaho	158	$68.97	$53.09	5
North Dakota	105	$37.54	$25.89	3
Kentucky	101	$74.26	$61.37	3
Montana	65	$99.26	$79.98	2
Vermont	48	$37.40	$25.88	1
West Virginia	24	$126.45	$92.11	1
Guam	11	$157.74	$106.16	1

Related codes

95886Needle measurement of electrical activity in arm or leg muscles$86.76
95816Measurement of brain wave activity (eeg)$227.96
95811Sleep study in sleep lab$314.61
95810Sleep study in sleep lab (6 years or older)$309.74
95819Measurement of brain wave activity (eeg)$239.95
95885Needle measurement of electrical activity in arm or leg muscles$46.74
95806Sleep study including heart rate$54.06
95874Needle measurement of electrical activity in muscle$53.46
95861Needle measurement of electrical activity in arm or leg muscles$80.08
95870Needle measurement of electrical activity in arm$19.70
95813Measurement of brain wave activity (eeg)$202.49
95812Measurement of brain wave activity (eeg)$191.83

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.