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 | $117.72 | 1689107724 - BRITTANY MAYS | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | MA | Physical Medicine & Rehabilitation Physician (208100000X) |
United | 95806 | $117.72 | 1427491885 - IZABELA GALDYN | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Plastic and Reconstructive Surgery Physician (2086S0122X) |
United | 95806 | $274.32 | 1770193005 - BRANDI WETHINGTON | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Family Nurse Practitioner (363LF0000X) |
United | 95806 | $274.32 | 1235186610 - CATHERINE VIROSTKO | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Advanced Practice Midwife (367A00000X) |
United | 95806 | $111.18 | 1396183505 - COLBY GLIDEWELL | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Audiologist (231H00000X) |
United | 95806 | $290.47 | 1497100259 - HELEN LIN | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Hospitalist Physician (208M00000X) |
United | 95806 | $146.83 | 1386036572 - REBECCA JONES | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Occupational Therapist (225X00000X) |
United | 95806 | $100.05 | 1184223695 - DANIELLE OGG | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Acute Care Nurse Practitioner (363LA2100X) |
United | 95806 | $211.00 | 1588283501 - ANNA HUGHES | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | MN | Student in an Organized Health Care Education/Training Program (390200000X) |
United | 95806 | $322.75 | 1750624292 - VINEET AGRAWAL | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | MD | Cardiovascular Disease Physician (207RC0000X) |
United | 95806 | $146.83 | 1689835282 - SARAH GARRAND | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Family Nurse Practitioner (363LF0000X) |
United | 95806 | $130.80 | 1427315472 - MICHAEL CHI | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Pain Medicine (Anesthesiology) Physician (207LP2900X) |
United | 95806 | $143.77 | 1528487667 - KARISA GRIZZLE | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Hospitalist Physician (208M00000X) |
United | 95806 | $211.00 | 1215223144 - CAITLYN MOONEY | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Pediatric Sports Medicine Physician (2080S0010X) |
United | 95806 | $100.05 | 1053408187 - BARBARA DUFFY | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Pediatric Nurse Practitioner (363LP0200X) |
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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