{
    "code": "95811",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/95811/2022/A",
    "release_specific_url": "https://localishealth.com/cpt/95811/2022/D",
    "description": "The same attended overnight laboratory sleep recording, but with positive airway pressure therapy started and tuned during the night. Once enough apnoea events have been recorded, the technologist fits a mask and steps the pressure up or down through the night to find the setting that keeps the airway open in every sleep stage and body position. Sometimes the whole night is devoted to titration; sometimes the night is split, with diagnosis in the first half and the mask in the second. The distinction from the plain overnight study is simply whether pressure therapy was applied and adjusted.",
    "answer": {
        "question": "How much did Medicare pay for CPT 95811 in Q4 2022?",
        "text": "Medicare paid $649.21 for CPT 95811 in the office (non-facility) setting and $649.21 in a facility under the Q4 2022 Physician Fee Schedule, effective October 2022. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2022, when it decreased 1.1%."
    },
    "release": {
        "schedule": "pfs",
        "year": 2022,
        "quarter": "D",
        "label": "Q4 2022",
        "effective": "October 1 – December 31, 2022",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 649.21,
        "facility": 649.21,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 2.6,
        "practice_expense_non_facility": 15.95,
        "practice_expense_facility": 15.95,
        "malpractice": 0.21
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 34.6062,
    "source": {
        "label": "Physician relative value file (Q4 2022)",
        "cms_url": "https://www.cms.gov/files/zip/rvu22d.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2022/D",
        "file": "PPRRVU22_OCT.csv",
        "row": 17114,
        "sha256": "f8774a019545e1fd71536837b20b74674c014b1acef3435d93456857885190ab"
    },
    "modified_at": "2026-08-04T03:12:03+00:00"
}