CPT 95807 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 • 52 - Reduced Services |
| Complexity Level | Moderate |
National average reimbursement for CPT 95807 by major payers:
$429.90
$572.11
$554.99
$734.37
| 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 95807 | ||||||
United | 95807 | $441.07 | 1467426650 - WILLIAM MCLAIN | 43490832 - BIOSERENITY USA INC. | SC | Pulmonary Disease Physician (207RP1001X) |
United | 95807 | $597.59 | 1306474986 - MELVIN JOSEPH | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 95807 | $485.20 | 1922328426 - MAJED DALLOUL | 364340137 - (IL) SAINT ANTHONY HEALTH AFFILIATES | IL | Psychiatry Physician (2084P0800X) |
United | 95807 | $1183.81 | 1992024608 - WILLIAM HEALY | 273818647 | GA | Pulmonary Disease Physician (207RP1001X) |
United | 95807 | $1091.44 | 1386242493 - LEXINGTON HEALTH INC, CAROLINA PULMONARY AND CRITICAL CARE | 852276567 - LEXINGTON HEALTH INC | SC | Pulmonary Disease Physician (207RP1001X) |
United | 95807 | $89.91 | 1801104559 - JOHN PATRICK TEJADA | 270623555 - SELF MEDICAL GROUP | SC | Pulmonary Disease Physician (207RP1001X) |
United | 95807 | $450.48 | 1013112614 - CHRISTY SINE | 134290167 - ST FRANCIS PHYSICIAN SERVICES INC | SC | Pulmonary Disease Physician (207RP1001X) |
United | 95807 | $332.82 | 1093592644 - ANSIBLE HEALTH MEDICAL GROUP PA | 883238466 | NV | Pulmonary Disease Physician (207RP1001X) |
United | 95807 | $118.83 | 1700099025 - EDWIN MERESH | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 95807 | $55.31 | 1538173794 - MICHAEL DENENBERG | 571101256 - (SC) SOUTHEAST PULMONARY & CRITICAL CARE, LLC | SC | Pulmonary Disease Physician (207RP1001X) |
United | 95807 | $964.21 | 1467898767 - TODD GANDY | 561398929 | SC | Pulmonary Disease Physician (207RP1001X) |
United | 95807 | $784.34 | 1386621217 - MARCUM QUINN | 571004971 - PRISMA HEALTH-UNIVERSITY MEDICAL GROUP | IN | Pulmonary Disease Physician (207RP1001X) |
United | 95807 | $484.33 | 1184620783 - SHYAM YALLAPRAGADA | 370661199 - DECATUR MEMORIAL HOSPITAL | SC | Pulmonary Disease Physician (207RP1001X) |
United | 95807 | $102.19 | 1346290780 - ABHINAV GUPTA | 471345819 - (SC) PRISMA HEALTH MEDICAL GROUP-MIDLANDS | SC | Pulmonary Disease Physician (207RP1001X) |
United | 95807 | $50.27 | 1093592644 - ANSIBLE HEALTH MEDICAL GROUP PA | 883238466 | HI | Pulmonary Disease Physician (207RP1001X) |
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 95807 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 95807 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 95807 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 |
| 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) |
| 95807-CPT | Moderate | Sleep Study, Simultaneous Recording Of Ventilation, Respiratory Effort, Ecg Or Heart Rate, And Oxygen Saturation, Attended By A Technologist |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95807. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95807 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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