How much does Medicare pay for CPT 95806?

Medicare allowed an average of $54.06 per service and paid $40.19 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $321.17, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 95806?

Sleep study including heart rate, breathing, airflow, and effort. It was billed 84,883 times to 81,005 Medicare beneficiaries by 1,688 providers in 2024.

Does 95806 pay differently in an office than a hospital?

Yes. The allowed amount averaged $63.20 in an office setting and $42.09 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 95806 most?

Pulmonary Disease, with 39,221 services from 785 clinicians. Next are Sleep Medicine, Neurology, Internal Medicine.

CPT 95806

Sleep study including heart rate, breathing, airflow, and effort

$54.06Medicare-allowed amount per service, averaged across 84,883 services

Providers submitted

$321.17

Asking price, not received

Medicare allowed

$54.06

The fee schedule figure

Medicare paid

$40.19

Balance is patient coinsurance

Providers submitted an average of $321.17 for this code and Medicare allowed $54.06 — 5.9× 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 $40.19 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $63.20
Hospital / facility: $42.09

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. 48,130 services were billed in an office setting and 36,753 in a facility.

Services: 84,883
Beneficiaries: 81,005
Providers billing it: 1,688
Total allowed: $4,588,775

What Medicare pays for CPT 95806

Across 84,883 services billed by 1,688 providers to 81,005 beneficiaries, Medicare allowed an average of $54.06 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 95806

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pulmonary Disease	39,221	37,818	$52.91	785
Sleep Medicine	15,334	14,961	$50.60	264
Neurology	9,325	8,968	$55.51	196
Internal Medicine	6,702	6,479	$54.71	152
Critical Care (Intensivists)	3,643	3,550	$57.36	86
Independent Diagnostic Testing Facility (IDTF)	3,571	2,568	$66.89	44
Otolaryngology	2,545	2,378	$57.88	64
Family Practice	1,800	1,729	$50.29	39
Cardiology	612	501	$68.57	11
Pediatric Medicine	552	549	$56.39	12
Psychiatry	451	421	$59.27	11
Nurse Practitioner	216	215	$35.19	1
Physical Medicine and Rehabilitation	185	179	$60.72	1
Sports Medicine	148	146	$88.70	2
Hospitalist	144	143	$41.67	4

95806 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
Texas	6,828	$59.33	$45.67	95
California	6,591	$73.77	$49.55	133
Pennsylvania	4,771	$48.75	$35.50	83
Florida	4,279	$58.52	$43.81	87
Ohio	3,797	$42.21	$32.32	97
Illinois	3,476	$46.36	$33.98	71
New York	3,470	$63.32	$43.43	74
New Jersey	3,317	$55.47	$38.13	71
Colorado	2,795	$53.98	$38.54	40
Massachusetts	2,761	$46.05	$32.50	41
Virginia	2,638	$66.40	$50.65	57
Tennessee	2,560	$50.47	$40.70	62
North Carolina	2,464	$50.65	$39.33	59
South Carolina	2,260	$49.94	$39.16	41
Missouri	2,251	$42.66	$32.49	40
Kentucky	2,227	$41.80	$32.46	35
Michigan	1,902	$64.59	$48.46	64
Indiana	1,748	$44.18	$33.06	39
Maryland	1,721	$73.41	$53.26	39
Utah	1,720	$45.32	$32.59	28
Nebraska	1,555	$40.55	$30.78	19
Wisconsin	1,504	$45.09	$34.17	29
Oklahoma	1,442	$43.90	$33.90	27
Georgia	1,383	$67.00	$51.57	37
Connecticut	1,354	$66.38	$46.11	33
Minnesota	1,265	$45.26	$33.86	33
Iowa	1,218	$41.41	$32.26	10
Kansas	1,181	$55.23	$42.04	22
Arizona	1,119	$56.65	$42.76	26
Washington	1,067	$44.96	$32.05	26
New Mexico	963	$42.65	$32.36	9
Oregon	901	$49.38	$36.46	14
Delaware	892	$59.16	$44.50	10
Alabama	836	$58.98	$46.85	23
Mississippi	832	$42.23	$33.71	20
West Virginia	688	$49.71	$39.50	21
Maine	579	$55.61	$39.04	9
Arkansas	495	$40.29	$30.79	7
Louisiana	484	$42.81	$34.19	16
Rhode Island	381	$57.47	$42.28	7
Nevada	267	$81.48	$65.13	7
Montana	210	$44.59	$31.95	6
New Hampshire	176	$44.07	$31.76	4
Vermont	130	$41.41	$30.11	2
Alaska	111	$57.53	$33.62	4
South Dakota	90	$41.10	$32.28	3
Idaho	85	$45.07	$35.29	4
Hawaii	55	$42.12	$30.66	2
North Dakota	32	$41.84	$31.35	1
Puerto Rico	12	$88.61	$72.85	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
95800Sleep study including heart rate$117.17
95819Measurement of brain wave activity (eeg)$239.95
95885Needle measurement of electrical activity in arm or leg muscles$46.74
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.