How much does Medicare pay for CPT 95810?

Medicare allowed an average of $309.74 per service and paid $240.14 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1210.10, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 95810?

Sleep study in sleep lab (6 years or older). It was billed 173,192 times to 168,523 Medicare beneficiaries by 3,413 providers in 2024.

Does 95810 pay differently in an office than a hospital?

Yes. The allowed amount averaged $437.38 in an office setting and $113.33 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 95810 most?

Pulmonary Disease, with 63,627 services from 1,425 clinicians. Next are Sleep Medicine, Neurology, Independent Diagnostic Testing Facility (IDTF).

CPT 95810

Sleep study in sleep lab (6 years or older)

$309.74Medicare-allowed amount per service, averaged across 173,192 services

Providers submitted

$1210.10

Asking price, not received

Medicare allowed

$309.74

The fee schedule figure

Medicare paid

$240.14

Balance is patient coinsurance

Providers submitted an average of $1210.10 for this code and Medicare allowed $309.74 — 3.9× 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 $240.14 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $437.38
Hospital / facility: $113.33

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. 104,971 services were billed in an office setting and 68,221 in a facility.

Services: 173,192
Beneficiaries: 168,523
Providers billing it: 3,413
Total allowed: $53,644,490

What Medicare pays for CPT 95810

Across 173,192 services billed by 3,413 providers to 168,523 beneficiaries, Medicare allowed an average of $309.74 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 95810

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pulmonary Disease	63,627	62,364	$265.32	1,425
Sleep Medicine	34,248	32,983	$271.35	606
Neurology	22,284	21,830	$287.94	449
Independent Diagnostic Testing Facility (IDTF)	20,370	19,253	$542.77	228
Internal Medicine	11,987	11,741	$315.60	289
Critical Care (Intensivists)	5,764	5,684	$272.36	134
Otolaryngology	4,830	4,744	$318.37	84
Family Practice	3,930	3,887	$280.74	71
Psychiatry	1,639	1,588	$251.72	34
Pediatric Medicine	1,035	1,011	$206.30	21
Cardiology	1,033	1,023	$441.42	18
Allergy/ Immunology	586	582	$659.04	5
Hospitalist	350	344	$192.85	12
Neuropsychiatry	181	179	$203.57	4
Physical Medicine and Rehabilitation	168	166	$121.60	1

95810 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
California	17,475	$521.39	$346.73	235
Florida	13,786	$387.84	$311.57	240
Texas	12,760	$316.67	$254.78	239
Ohio	7,907	$170.97	$137.96	165
Illinois	7,194	$249.31	$191.53	166
New York	6,839	$338.29	$233.89	171
Virginia	6,171	$389.25	$298.41	114
North Carolina	6,105	$308.57	$255.79	124
Pennsylvania	5,706	$192.45	$146.72	152
Tennessee	5,313	$285.66	$242.27	94
Maryland	5,216	$429.86	$312.17	89
Indiana	4,302	$172.90	$139.80	81
Michigan	4,271	$247.62	$196.49	109
Arizona	4,208	$435.66	$348.35	66
South Carolina	4,187	$286.16	$237.51	64
Georgia	4,057	$312.52	$256.81	108
Washington	3,837	$288.44	$211.07	83
Alabama	3,654	$194.42	$164.52	66
Massachusetts	3,431	$289.09	$211.04	84
Missouri	3,415	$175.24	$139.88	87
New Jersey	3,189	$284.62	$201.58	90
Oklahoma	2,912	$161.86	$132.05	35
Mississippi	2,653	$223.13	$190.30	38
Arkansas	2,575	$162.01	$138.06	30
Wisconsin	2,241	$149.64	$117.77	66
Minnesota	2,078	$321.15	$245.75	58
Colorado	1,973	$234.73	$177.31	39
Kentucky	1,953	$148.42	$119.00	44
Louisiana	1,843	$249.36	$216.99	40
Utah	1,836	$285.87	$232.94	29
Oregon	1,784	$337.32	$256.64	43
Iowa	1,772	$268.36	$223.55	28
Connecticut	1,735	$220.80	$158.00	44
Nevada	1,499	$566.77	$448.29	22
Delaware	1,216	$408.64	$321.73	17
Kansas	1,212	$227.95	$190.35	30
New Mexico	1,167	$279.25	$230.68	17
New Hampshire	1,165	$204.92	$159.52	23
West Virginia	1,081	$180.97	$153.85	30
Idaho	1,034	$201.00	$163.86	26
Montana	948	$324.62	$250.93	12
North Dakota	879	$150.43	$114.37	13
Maine	804	$174.47	$132.81	17
South Dakota	774	$113.86	$87.82	11
Nebraska	677	$162.91	$131.36	22
Alaska	658	$575.03	$408.79	14
District of Columbia	502	$537.32	$366.05	7
Vermont	365	$193.93	$149.02	7
Hawaii	281	$432.42	$298.64	7
Rhode Island	214	$305.33	$233.02	7
Wyoming	120	$465.59	$360.40	3
U.S. Virgin Islands	110	$575.41	$467.50	4
Guam	65	$381.47	$245.20	1
Puerto Rico	43	$609.96	$464.28	2

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
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
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.