Current Procedural Terminology (CPT) codes provide a standardized language for describing medical services and procedures for billing and documentation. These codes, maintained by the American Medical Association (AMA), ensure consistency across the healthcare system for reporting services delivered to patients. CPT 95810 specifically falls within the category of sleep medicine testing and long-term monitoring, representing a comprehensive evaluation of brain and body functions during sleep.
The Specific Medical Procedure
CPT code 95810 represents Polysomnography (PSG), a full-night, attended sleep study conducted in a specialized laboratory setting. The code is defined as polysomnography lasting six or more hours, which includes sleep staging and the continuous, simultaneous monitoring of at least four physiological parameters.
The parameters monitored during this extensive study include an electroencephalogram (EEG) to record brain waves for sleep staging, an electrooculogram (EOG) to track eye movements, and an electromyogram (EMG) to monitor muscle activity. Other simultaneously recorded data includes airflow, respiratory effort, oxygen saturation levels, and heart rate.
The process is non-invasive, requiring a trained technologist to place numerous electrodes and sensors on the patient’s scalp, face, chest, and limbs before the patient attempts to sleep in the lab. The technologist remains in an adjacent control room, continuously monitoring the collected data and the patient’s condition for the entire duration of the study.
Clinical Reasons for Ordering the Test
A physician orders a diagnostic polysomnography (95810) primarily to investigate conditions that disrupt or are associated with abnormal sleep architecture. The test aids in the medical evaluation of chronic fatigue, poor sleep quality, or excessive daytime sleepiness that lacks a clear cause.
The most common reason for ordering this test is the suspicion of Obstructive Sleep Apnea (OSA), where the patient’s breathing repeatedly stops and starts during sleep. The data collected by the respiratory effort and oxygen saturation sensors are used for confirming the diagnosis and determining its severity. The test also helps diagnose central sleep apnea, which is caused by a failure of the brain to signal the muscles to breathe.
CPT 95810 is used to identify other neurological sleep disorders, such as narcolepsy and parasomnias. Narcolepsy is characterized by excessive daytime sleepiness and sudden sleep attacks, which can be identified by the rapid entry into REM sleep during the study. Parasomnias, which include sleepwalking or night terrors, are diagnosed by correlating the patient’s physical movements (captured by video and EMG) with specific patterns of brain activity (EEG) while asleep.
Understanding Variations of the Service
CPT 95810 is distinguished from other brain monitoring services, which are reported using entirely different codes. A routine Electroencephalogram (EEG) is a shorter procedure, typically lasting only 20 to 40 minutes, and is coded under the 95816 or 95819 series.
These routine EEG codes focus exclusively on brain activity while the patient is awake, drowsy, or spontaneously asleep, without the extensive body parameter monitoring of a PSG.
If the patient’s symptoms suggest a need for longer EEG monitoring but not a full sleep study, extended EEG codes like 95812 (41 to 60 minutes) or 95813 (61 to 119 minutes) are used. The difference is based on recording time and data complexity.
Another common variation is the split-night polysomnography, coded as CPT 95811, which is a PSG where the first half is diagnostic, and the second half is used to titrate Positive Airway Pressure (PAP) therapy. This variation is used when severe sleep apnea is diagnosed early in the night, allowing the treatment to begin immediately. In contrast, CPT 95810 is used for purely diagnostic purposes, where no PAP titration is performed during the study.
For monitoring that lasts longer than two hours, such as a 24-hour ambulatory EEG or continuous video-EEG monitoring in a hospital setting, the 95700 series codes are used instead. These prolonged studies require more specialized equipment and often involve continuous or intermittent technologist monitoring over many hours to capture rare neurological events. The distinction between all these codes rests on the total recording time, the number of physiological parameters measured, and the presence of continuous technologist or physician attendance.