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Home Sleep Study Test Procedure Code 95800 to Become a Benefit Effective March 1, 2025

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective for dates of service on or after March 1, 2025, a new home sleep study test, procedure code 95800, will become a benefit of Texas Medicaid for clients who are 18 years of age or older.

Procedure code 95800 applies to a device that measures three or more channels, including pulse oximetry, actigraphy, and peripheral arterial tone (PAT).

Procedure code 95800 is limited to one study per day, any provider, and two tests per rolling year, any provider, and may be reimbursed to the following provider types and places of service:

Place of ServiceProvider Type
OfficePhysician, Portable X-Ray, Radiological and Physiological Lab
Outpatient HospitalHospital, Portable X-Ray, Radiological and Physiological Lab, Rural Emergency Hospital

For more information, call the TMHP Contact Center at 800-925-9126.