CPT 95811 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 | Moderate |
| Medicare Fee Schedule | View Medicare rates for 95811 |
National average reimbursement for CPT 95811 by major payers:
$695.59
$896.03
$953.46
$1,154.33
| 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 95811 | ||||||
United | 95811 | $1558.94 | 1669405130 - VINCENT NOVAK | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Orthopaedic Hand Surgery Physician (207XS0106X) |
United | 95811 | $1352.03 | 1124426762 - ANITA PAI | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Transplant Hepatology Physician (207RT0003X) |
United | 95811 | $1325.09 | 1194496752 - KATHERINE GOLEY | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Women's Health Nurse Practitioner (363LW0102X) |
United | 95811 | $131.69 | 1790123024 - NRIPEN DONTINENI | 462219798 - (NJ) JFK MEDICAL ASSOCIATES PA | NJ | Internal Medicine Physician (207R00000X) |
United | 95811 | $429.02 | 1184945552 - SHING LI | 222306589 - (NJ) RANDOLPH MEDICAL & RENAL ASSOC., PA | NJ | Internal Medicine Physician (207R00000X) |
United | 95811 | $99.01 | 1033153689 - ANDREW ROMANO | 204924321 - (NJ) DR ANDREW L ROMANO DO LLC | NJ | Internal Medicine Physician (207R00000X) |
United | 95811 | $1472.33 | 1821345265 - LAUREN HARRISON | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | CO | Pediatric Nurse Practitioner (363LP0200X) |
United | 95811 | $118.45 | 1750380358 - SAMIH ABBASSI | 932022071 - (NJ) EXCEL MEDICAL GROUP PC | NJ | Internal Medicine Physician (207R00000X) |
United | 95811 | $515.03 | 1669404000 - JOSEPH LIOTTA | 264532646 - (NJ) OMNEITY HEALTH CARE | NJ | Internal Medicine Physician (207R00000X) |
United | 95811 | $1366.56 | 1336536465 - ANN TUCKER | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Obstetrics & Gynecology Physician (207V00000X) |
United | 95811 | $307.91 | 1538459235 - SERGEY BLINTSOVSKIY | 453023019 - (NY) NORTH SHORE-LIJ MEDICAL PC | NJ | Internal Medicine Physician (207R00000X) |
United | 95811 | $1366.56 | 1134649585 - CONNOR SNARSKIS | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Anesthesiology Physician (207L00000X) |
United | 95811 | $310.76 | 1841397031 - JODI ROBBE | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Physician Assistant (363A00000X) |
United | 95811 | $581.97 | 1780663898 - KUMAR RAMDAS | 812861717 - (NJ) ORION HEALTHCARE LLC | NJ | Internal Medicine Physician (207R00000X) |
United | 95811 | $1558.94 | 1972581171 - WICHAI CHINRATANALAB | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Hematology & Oncology Physician (207RH0003X) |
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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 95811 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 95811 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 95811 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 |
|---|---|---|
| 95782-CPT | High | Polysomnography; Younger Than 6 Years Sleep Staging With 4 Or More Additional Parameters Of Sleep Attended By A Technologist |
| 95783-CPT | High | Polysomnography; Younger Than 6 Years Sleep Staging With 4 Or More Additional Parameters Of Sleep With Initiation Of Continuous Positive Airway Pressure Therapy Or Bi-Level Ventilation Attended By A Technologist |
| 95806-CPT | Low | Sleep Study, Unattended, Simultaneous Recording Of, Heart Rate, Oxygen Saturation, Respiratory Airflow, And Respiratory Effort (Eg, Thoracoabdominal Movement) |
| 95811-CPT | Moderate | Polysomnography; Age 6 Years Or Older Sleep Staging With 4 Or More Additional Parameters Of Sleep With Initiation Of Continuous Positive Airway Pressure Therapy Or Bilevel Ventilation Attended By A Technologist (Revised 1/1/2013) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95811. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95811 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 95811) and we'll show you how you compare in 15 minutes or less.