05/01/2025
What’s new: As of March 1, 2025, Sleep Studies Medicaid Policy procedure code 95800 is a benefit for Texas Medicaid members who are 18 years of age or older.
Highlights to the policy update for procedure code 95800
- Expands the Sleep Studies Medicaid Policy to now include a new home sleep study test
- Describes a device that measures three or more channels, including pulse oximetry, actigraphy and peripheral arterial tone
- Clarifies diagnosis restrictions and prior authorization requirements
- Clarifies reimbursement and billing guidelines
Limitations
- Limited to one study per day and two tests per rolling year with any provider
Places of service and provider types
- Office: Physician, portable X-ray, radiological and physiological lab
- Outpatient hospital: Hospital, portable X-ray, radiological and physiological lab, rural emergency hospital
Resources
The Sleep Studies Medicaid Policy for procedure code 95800 is updated in the Texas Medicaid Provider Procedure Manual, Medical and Nursing Specialists, Physicians and Physician’s Assistant Handbook Section 9.2.71.5.
Questions
If you have questions or require assistance, please reach out to our Medicaid Provider Network Team at 855-212-1615 or email Texas Medicaid Network Department.