Proposed Home Sleep Testing CPT Codes Clear High Hurdle

By Sree Roy

Years of hard work to modernize the CPT codes for unattended sleep testing are finally paying off.

The American Medical Association (AMA)’s CPT panel accepted a new code set for home sleep testing (HST) at a meeting convened Feb 6-8, 2025, according to the CPT® Editorial Panel Summary of Panel Actions – February 2025. It also approved the deletion of CPT codes 95800, 95801, and 95806.

The American Academy of Sleep Medicine (AASM) has been working with the American Thoracic Society (ATS), the American College of Chest Physicians (CHEST), and the American Academy of Neurology (AAN) on updating these codes for several years. However, each time a proposed code set neared its presentation date at the CPT panel meeting, changes were needed that meant the set was withdrawn.

The most recent submission was different: The codes, presented by two physician advisors for each society at the February meeting, were approved. Though the proposed code set could still experience setbacks, the approval by the AMA’s CPT panel is a high hurdle that the codes have now cleared.

If all goes smoothly, the new codes, and the deletion of three current codes, will be effective as of Jan 1, 2027.

Many in the industry cheer the progress. Simultaneously, many express hope that a code set that better encompasses the utilization potential of modern HST equipment will steer sleep medicine into the future.

“CleveMed is very supportive of the AASM’s CPT code changes,” says Hani Kayyali, CEO and president of CleveMed. “Incorporating new technologies in unattended sleep testing, like AI and EEG, can further expand HST access to more patient populations, provided sleep study quality and ease of use are maintained. CleveMed has been a leader in HST for many years now and expects even stronger future growth with the new codes.”

Skip Ashmore, chief commercial officer at Onera, says, “We commend the AASM for its initiative to update and revise the HST code structure to reflect recent technological advancements, including the integration of home-based polysomnography (hPSG). Modern hPSG systems can capture the full array of signals required for a comprehensive sleep evaluation—providing differentiated diagnoses equivalent to in-lab testing. This includes the assessment of sleep architecture, limb movements, and a range of sleep disorders beyond obstructive sleep apnea (OSA), as isolated conditions and as comorbidities occurring with OSA, enabling clinicians to develop more targeted, personalized treatment plans that address the full spectrum of a patient’s sleep pathology. Expanding access to hPSG will enhance diagnostic capabilities and reduce the time to diagnosis and initiation of therapy.”

The release of more specific CPT code set information is timed with the release of the entire set of coding changes in the CPT publication. In other words, codes are not assigned, nor exact wording finalized, until just before publication. That won’t be until the middle of next year.

For now, the next step is for the code set to be valued. The RVS Update Committee (better known as “RUC”) will soon send its valuation decisions to the Centers for Medicare & Medicaid Services (CMS). The valuation will likely have an outsize impact on which HST devices will gain and lose market share.

“ZOLL Itamar commends the AASM for its leadership in developing new home sleep testing CPT codes and congratulates the entire sleep medicine community on their successful approval by the AMA CPT editorial panel,” says Etai Amitai, vice president of strategic planning and health economics at ZOLL Itamar. “We also recognize that the expanded scope of these tests will demand additional clinical work and resources. We are optimistic that reimbursement will reflect the increased complexity and clinical value of these services, ensuring access and sustainability for providers and patients alike.”

Because the HST coding situation is fluid with many stakeholders, coding-related questions are best addressed to [email protected].

A general overview of the timeline (including key events from this year that have already occurred), assuming the process goes smoothly, is as follows:

2025

(past) Feb 6-8, 2025: CPT panel meeting during which the AASM and sister societies resubmitted unattended sleep study codes. The panel approved the codes, as well as the deletion of three current codes.
(past) March 2025: A subset of AASM, ATS, CHEST, and AAN physician members were surveyed about the work and time involved before, during, and after providing unattended sleep studies to patients. Invoices were collected for devices that would fall under each code.
(past) April 1, 2025: Society recommendations on practice expense and physician work were due to AMA RUC.

(past) April 23-26, 2025: RUC meeting during which two physician advisors from each society presented their recommendations for how the approved codes should be valued.
Late May/early June 2025: The RUC posts decisions from the April meeting. RUC sends final recommendations to CMS.

2026

July 2026: CMS publishes physician fee schedule proposed rule (initial recommendations of the values of the new unattended sleep study codes), which will be open to public comment for 60 days.
July/August 2026: AASM anticipates posting a focused update to the clinical practice guideline for diagnostic testing for adult obstructive sleep apnea as an accepted paper in the Journal of Clinical Sleep Medicine.
November 2026: CMS finalizes payment rates in the physician fee schedule final rule.

2027

Jan 1, 2027 – The new unattended sleep study codes go into effect. CPT codes 95800, 95801, and 95806 are deleted.

Want us to dive deeper into an aspect of the proposed codes? Email editor[at]sleepreviewmag.com with your article requests, or reach out via the online comments section or social media.

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