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 |
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 | $365.60 | 1497166771 - ELIZABETH PERKINS | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Plastic Surgery within the Head & Neck (Otolaryngology) Physician (207YX0007X) |
United | 95811 | $329.04 | 1083110381 - MATTHEW SMITH | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Body Imaging Physician (2085B0100X) |
United | 95811 | $1325.09 | 1609942796 - RENE GIFFORD | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Audiologist (231H00000X) |
United | 95811 | $310.76 | 1841397031 - JODI ROBBE | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Physician Assistant (363A00000X) |
United | 95811 | $365.60 | 1336702976 - CARLTHAN LING | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Ophthalmology Physician (207W00000X) |
United | 95811 | $1732.17 | 1376690255 - MELISSA KAUFMAN | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Urology Physician (208800000X) |
United | 95811 | $279.67 | 1740908524 - JESSICA YURKOVICH | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | OH | Physician Assistant (363A00000X) |
United | 95811 | $1472.33 | 1770183055 - PAIGE SELLERS | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Gerontology Nurse Practitioner (363LG0600X) |
United | 95811 | $1229.91 | 1790218956 - MATTHEW MERIWEATHER | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Neurology Physician (2084N0400X) |
United | 95811 | $1366.56 | 1306870951 - KAREN GLADDEN | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | MO | Neuroradiology Physician (2085N0700X) |
United | 95811 | $310.76 | 1497925523 - SHAI BYNUM | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Pediatric Nurse Practitioner (363LP0200X) |
United | 95811 | $1472.33 | 1700383155 - SHAWNA WILEY | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Family Nurse Practitioner (363LF0000X) |
United | 95811 | $329.04 | 1306361605 - RASHMI DHITAL | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Rheumatology Physician (207RR0500X) |
United | 95811 | $361.70 | 1376787101 - MONICA LOPEZ | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Pediatric Surgery Physician (2086S0120X) |
United | 95811 | $1325.09 | 1194496752 - KATHERINE GOLEY | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Women's Health Nurse Practitioner (363LW0102X) |
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 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.
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