How much does Medicare pay for CPT 95811?

Medicare allowed an average of $314.61 per service and paid $244.75 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1256.98, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 95811?

Sleep study in sleep lab with continuous airway pressure (6 years or older). It was billed 184,086 times to 173,175 Medicare beneficiaries by 3,350 providers in 2024.

Does 95811 pay differently in an office than a hospital?

Yes. The allowed amount averaged $451.57 in an office setting and $117.17 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 95811 most?

Pulmonary Disease, with 71,903 services from 1,441 clinicians. Next are Sleep Medicine, Neurology, Independent Diagnostic Testing Facility (IDTF).

CPT 95811

Sleep study in sleep lab with continuous airway pressure (6 years or older)

$314.61Medicare-allowed amount per service, averaged across 184,086 services

Providers submitted

$1256.98

Asking price, not received

Medicare allowed

$314.61

The fee schedule figure

Medicare paid

$244.75

Balance is patient coinsurance

Providers submitted an average of $1256.98 for this code and Medicare allowed $314.61 — 4.0× 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 $244.75 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $451.57
Hospital / facility: $117.17

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. 108,689 services were billed in an office setting and 75,397 in a facility.

Services: 184,086
Beneficiaries: 173,175
Providers billing it: 3,350
Total allowed: $57,915,296

What Medicare pays for CPT 95811

Across 184,086 services billed by 3,350 providers to 173,175 beneficiaries, Medicare allowed an average of $314.61 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 95811

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pulmonary Disease	71,903	68,442	$262.68	1,441
Sleep Medicine	35,068	32,379	$282.98	573
Neurology	21,651	20,472	$297.91	411
Independent Diagnostic Testing Facility (IDTF)	20,672	18,785	$564.35	226
Internal Medicine	13,604	12,940	$333.08	287
Critical Care (Intensivists)	5,857	5,656	$261.31	140
Otolaryngology	4,795	4,543	$339.29	71
Family Practice	4,043	3,811	$273.55	73
Psychiatry	1,649	1,549	$253.38	36
Cardiology	1,238	1,176	$446.44	17
Pediatric Medicine	1,034	966	$219.44	20
Allergy/ Immunology	677	646	$665.58	5
Hospitalist	489	463	$179.14	11
Nurse Practitioner	162	154	$261.17	6
Emergency Medicine	159	153	$401.55	3

95811 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	17,334	$543.69	$367.12	241
Texas	14,488	$325.64	$264.55	232
Florida	12,603	$419.54	$338.16	229
Illinois	8,281	$262.20	$202.40	173
Ohio	7,615	$195.52	$161.03	160
Pennsylvania	6,060	$225.54	$173.35	142
New York	5,615	$358.33	$249.50	147
Virginia	5,491	$388.67	$300.32	101
Tennessee	5,476	$301.69	$255.51	87
North Carolina	5,453	$320.25	$268.43	121
Michigan	5,304	$268.78	$214.85	126
Arizona	5,163	$449.95	$360.44	71
Missouri	4,730	$168.87	$136.05	87
South Carolina	4,399	$281.82	$235.21	63
Colorado	4,236	$262.16	$202.88	52
Indiana	4,149	$162.97	$132.22	77
Alabama	4,097	$231.22	$198.92	67
Oklahoma	3,855	$158.72	$130.36	42
Maryland	3,804	$475.93	$346.10	79
Georgia	3,507	$305.40	$250.79	94
Washington	3,375	$274.17	$204.92	71
Massachusetts	3,288	$247.52	$181.75	76
Utah	3,243	$265.69	$213.99	35
New Jersey	2,870	$311.86	$220.71	82
Iowa	2,817	$244.89	$202.30	28
Wisconsin	2,795	$159.67	$126.37	64
Arkansas	2,551	$159.36	$134.93	26
Mississippi	2,433	$246.81	$214.81	37
Kentucky	2,352	$154.64	$125.32	49
Nevada	2,263	$583.68	$463.46	24
Oregon	2,260	$360.38	$276.12	45
Minnesota	2,250	$255.21	$192.63	71
Louisiana	2,093	$255.31	$223.20	43
Kansas	1,908	$233.14	$194.34	33
New Mexico	1,791	$282.56	$235.12	19
Nebraska	1,603	$164.61	$134.16	24
Montana	1,316	$310.69	$243.77	11
West Virginia	1,254	$208.26	$182.22	30
South Dakota	1,186	$119.98	$93.63	10
Idaho	1,173	$176.90	$145.48	23
New Hampshire	1,116	$245.60	$190.43	23
Connecticut	1,048	$234.40	$169.95	30
North Dakota	1,048	$150.28	$114.31	13
Delaware	978	$429.42	$338.72	18
Maine	761	$178.91	$139.19	16
Alaska	610	$518.31	$361.05	14
Hawaii	557	$440.39	$313.53	9
Vermont	307	$153.71	$116.37	6
District of Columbia	285	$523.44	$349.75	6
Puerto Rico	270	$499.37	$388.66	8
Rhode Island	261	$396.77	$297.58	8
Wyoming	201	$515.53	$401.33	3
U.S. Virgin Islands	96	$599.66	$498.43	3
Guam	67	$418.65	$292.57	1

Related codes

95886Needle measurement of electrical activity in arm or leg muscles$86.76
95816Measurement of brain wave activity (eeg)$227.96
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
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.