CPT 95806 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Neurology and Neuromuscular Procedures |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Low |
National average reimbursement for CPT 95806 by major payers:
$131.26
$194.09
$185.62
$218.68
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 95806 | ||||||
United | 95806 | $290.47 | 1497100259 - HELEN LIN | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Hospitalist Physician (208M00000X) |
United | 95806 | $130.80 | 1427315472 - MICHAEL CHI | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Pain Medicine (Anesthesiology) Physician (207LP2900X) |
United | 95806 | $80.34 | 1992764906 - SAMINA KHAN | 208848681 | NJ | Internal Medicine Physician (207R00000X) |
United | 95806 | $274.32 | 1770193005 - BRANDI WETHINGTON | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Family Nurse Practitioner (363LF0000X) |
United | 95806 | $73.91 | 1801138284 - ZORIC PROSKUROVSKY | 223172481 - (NJ) CAPE PHYSICIANS ASSOCIATES, PA | NJ | Internal Medicine Physician (207R00000X) |
United | 95806 | $172.75 | 1093378432 - CAMILLE ROBINSON | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Obstetrics & Gynecology Physician (207V00000X) |
United | 95806 | $54.90 | 1437144391 - GAUTAM SURANA | 1437144391 - (NJ) GAUTAM SURANA | NJ | Internal Medicine Physician (207R00000X) |
United | 95806 | $96.41 | 1265581714 - SOFIA SHAPIRO | 113671098 - (NJ) SOFIA SHAPIRO MD LLC | NJ | Internal Medicine Physician (207R00000X) |
United | 95806 | $290.47 | 1518958370 - JOHN FAHRENHOLZ | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Allergy & Immunology Physician (207K00000X) |
United | 95806 | $76.68 | 1962931550 - JAI BHATT | 811200310 - (NJ) CAPITAL HEALTH MULTISPECIALTY GROUP | NJ | Internal Medicine Physician (207R00000X) |
United | 95806 | $29.98 | 1124368469 - VIJAY SAARASWAT MEDICAL LLC | 273453208 - (NJ) VIJAY SAARASWAT MEDICAL, LLC | NJ | Internal Medicine Physician (207R00000X) |
United | 95806 | $143.77 | 1376519967 - JEFFREY UPPERMAN | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | PA | Pediatric Surgery Physician (2086S0120X) |
United | 95806 | $72.91 | 1265573166 - TIMOTHY SASS | 223457805 - (NJ) PRINCETON INTERNAL MEDICINE ASSOCIATES, P.C. | NJ | Internal Medicine Physician (207R00000X) |
United | 95806 | $31.82 | 1649337296 - NITIN PARIKH | 223516270 - (NJ) APEX MEDICAL ASSOCIATES PA | NJ | Internal Medicine Physician (207R00000X) |
United | 95806 | $74.48 | 1225567720 - VINIT SHAH | 463142095 | NJ | Internal Medicine Physician (207R00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 95806 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 95806 code is part of the Medicine Services and Procedures services used for Neurology and Neuromuscular Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 95806 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 95800-CPT | Low | Sleep Study, Unattended, Simultaneous Recording; Heart Rate, Oxygen Saturation, Respiratory Analysis (Eg, By Airflow Or Peripheral Arterial Tone), And Sleep Time |
| 95801-CPT | Low | Sleep Study, Unattended, Simultaneous Recording; Minimum Of Heart Rate, Oxygen Saturation, And Respiratory Analysis (Eg, By Airflow Or Peripheral Arterial Tone) |
| 95805-CPT | Moderate | Multiple Sleep Latency Or Maintenance Of Wakefulness Testing, Recording, Analysis And Interpretation Of Physiological Measurements Of Sleep During Multiple Trials To Assess Sleepiness |
| 95806-CPT | Low | Sleep Study, Unattended, Simultaneous Recording Of, Heart Rate, Oxygen Saturation, Respiratory Airflow, And Respiratory Effort (Eg, Thoracoabdominal Movement) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95806. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95806 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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