Sleep medicine specialists diagnose and treat sleep disorders including obstructive sleep apnea, insomnia, narcolepsy, and REM sleep behavior disorder. Accurate ICD-10 coding and proper polysomnography billing are essential for Medicare and commercial payer reimbursement. This page lists the top codes used in sleep medicine practices.
FY 2026 ICD-10-CM (CMS) · CPT codes updated annually · All codes verified billable · Last verified: June 2026
Office visit, established patient, low to moderate complexity (20-29 minutes)
~$93
-25, -95, -GT
99214
Office visit, established patient, moderate to high complexity (30-39 minutes)
~$134
-25, -95, -GT
99215
Office visit, established patient, high complexity (40-54 minutes)
~$188
-25, -95, -GT
99205
Office visit, new patient, high complexity (60-74 minutes)
~$229
-25, -95, -GT
94660
Continuous positive airway pressure ventilation (CPAP), initiation and management
~$62
-25, -59
94762
Noninvasive oximetry for oxygen saturation; by continuous overnight monitoring
~$34
-26, -TC
99401
Preventive medicine counseling, individual, 15 minutes (sleep hygiene, lifestyle modification)
~$43
-25
*Approximate 2025 CMS national non-facility rate. Rates vary by geography, setting, and payer contract. Refer to the CMS Physician Fee Schedule for official rates.
Top Denial Reasons for Sleep Medicine Claims
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Medical Necessity Not Adequately Documented
Payers require documentation of AHI scores, Epworth Sleepiness Scale results, and failed conservative measures before approving sleep studies or CPAP. Include all objective clinical findings and prior treatment attempts in the medical record.
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Missing or Incorrect Prior Authorization for Sleep Studies
Many commercial payers require prior authorization for polysomnography (95810, 95811) and home sleep testing before the study is performed. Verify payer requirements in advance and document the auth number on the claim.
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Incorrect Diagnosis-Procedure Code Linkage
Billing CPT 95811 (CPAP titration PSG) with only a snoring diagnosis (R06.83) without a confirmed or suspected sleep apnea code (G47.30, G47.33) triggers automatic denial. Ensure the linked ICD-10 code supports the clinical necessity of the procedure.
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Split-Bill Issues: Missing Modifier -26 or -TC
When the interpreting physician and the facility are billing separately for sleep studies, failure to append modifier -26 (professional component) or -TC (technical component) results in duplicate-service denials. Always split-bill with the correct modifier when the physician does not own the testing equipment.
Sleep Medicine Billing & Coding Tips
G47.33 (obstructive sleep apnea) is distinct from G47.31 (primary central sleep apnea) and G47.30 (unspecified sleep apnea) — specify the type based on the sleep study interpretation.
Polysomnography (95810) requires a minimum of 4 additional channels beyond airflow, oxygen saturation, and heart rate to be billed correctly.
CPAP titration study (95811) must be a full attended polysomnography with CPAP applied — home sleep apnea tests (95800) cannot be used for titration.
Document the AHI, RDI, and nadir oxygen saturation in every sleep study interpretation report to support G47.33 diagnosis and CPAP/BiPAP equipment orders.
G47.33 is Obstructive Sleep Apnea (OSA) — the most common sleep apnea code. G47.31 is Central Sleep Apnea. G47.30 is unspecified and should be avoided when the type has been determined by sleep study. The OSA code supports CPAP/BiPAP equipment orders and prior authorization.
What is the difference between 95810 and 95811?
95810 is a diagnostic polysomnography (sleep staging with 4+ parameters) without PAP therapy. 95811 is a CPAP titration polysomnography, performed when OSA has already been diagnosed and CPAP pressure needs to be set. Both require a technologist in attendance.
Can a home sleep test diagnose OSA?
Yes. 95800 (home sleep apnea test, 3+ channels) can diagnose uncomplicated OSA in adults without significant comorbidities per CMS coverage. However, it cannot be used for CPAP titration — a full in-lab polysomnography (95811) is required for titration.
What is the ICD-10 code for insomnia?
G47.00 is Insomnia, unspecified. F51.01 is Primary insomnia (when no underlying medical or psychiatric cause is identified). G47.01 is Insomnia due to a medical condition. Code the most specific type supported by the documentation.
How does OmniMD support sleep medicine practices?
OmniMD’s Sleep Medicine EHR integrates polysomnography report uploads, AHI-based diagnosis coding suggestions, CPAP compliance tracking (from ResMed/Philips data feeds), and DME order management with medical necessity documentation.
Streamline Your Sleep Medicine Practice with OmniMD
Purpose-built EHR, billing, and practice management for Sleep Medicine practices.
