The Centers for Medicare & Medicaid Services (CMS) has finalized the calendar year 2027 Medicare Physician Fee Schedule values for the new unattended sleep testing Current Procedural Terminology (CPT) code family, which replaces CPT codes 95800, 95801, and 95806. The six new codes, CPT 95843, 95844, 95846, 95847, 95848, and 95849, distinguish unattended sleep testing services based on study complexity and separate the technical aspects of testing from physician or other qualified healthcare professional interpretation and reporting.

Key takeaways  

  • CPT 95849: Following significant feedback from the AASM and other stakeholders, CMS increased the final work relative value unit (RVU) from the proposed 1.42 to 1.50, agreeing that the proposed value did not fully account for the clinical work and intensity associated with interpreting a high-complexity unattended sleep study. Although commenters supported the Relative Value Scale Update Committee (RUC)-recommended value of 1.60, CMS determined that 1.50 work RVUs better preserves the relative progression in physician work across the three professional codes in the code family. 
  • CPT 95843, 95844 and 95846: CMS finalized the direct practice expense inputs as proposed for these technical services. 
  • Equipment and supplies for CPT 95844: CMS considered extensive stakeholder feedback, including approximately 800 submitted invoices, but was not persuaded that use of a disposable device is more typical than the reusable equipment included in the proposed practice expense inputs. CMS therefore did not replace the reusable equipment with a disposable supply in the direct practice expense inputs for CPT 95844. 
  • Utilization crosswalk: CMS accepted a technical correction to the utilization crosswalk for the new code family. For calendar year 2027, CPT 95843 and 95847 will crosswalk from deleted CPT 95800, while CPT 95844 and 95848 will crosswalk from deleted CPT 95806. 

 

Thank you to all who submitted comments to CMS in alignment with AASM’s recommendations, as those comments ultimately impacted the agency’s final decision regarding RVUs for the code family. Practices should continue preparing their coding, billing, and documentation workflows to ensure that the appropriate technical and professional codes are selected based on the complexity of the unattended sleep study. 

 

AASM members should watch for a complete analysis of the Physician Fee Schedule Final Rule. In the meantime, members may send questions about the values for the unattended sleep testing codes to coding@aasm.org.