CPT 95803, in plain terms, covers Actigraphy testing with a wearable motion sensor recorded for at least 72 hours, including scoring, analysis, and interpretation with report. CPT 95803 is referenced in 13 tracked payer policy changes from Sentara Health Plans, Anthem BCBS, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 95803 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 95803 on AAPC
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
Effective September 1, 2026, Anthem will require precertification/prior authorization for 29 new medical codes including diagnostic tests, surgical procedures, and specialized treatments for MyCare Ohio FIDE (Fully Integrated Dual Eligible) members. Services performed without proper authorization may be denied payment.
Effective September 1, 2026, Anthem will require prior authorization for 25 new medical codes across multiple specialties for Medicare Advantage members in California. These include gastroenterology tests, drug assays, oncology procedures, neurostimulation devices, and various surgical procedures.
Effective September 1, 2026, Anthem will require prior authorization for 28 additional medical codes for Medicare Advantage members in Virginia, including gastroenterology tests, neurostimulation procedures, and fertility treatments. Services performed without obtaining required precertification may be denied for payment.
Effective September 1, 2026, Anthem Medicare Advantage plans will require precertification/prior authorization for 26 specific medical codes including gastroenterology tests, neurostimulation procedures, spinal decompressions, and various specialized treatments. Services performed without proper authorization may be denied payment.
Anthem Medicare Advantage plans in California will require prior authorization for 27 specific medical codes starting September 1, 2026. These codes cover specialized procedures including neurostimulation, oncology testing, gastric procedures, and fertility treatments.
Effective September 1, 2026, Anthem will require precertification/prior authorization for 25 new medical codes across multiple specialties including gastroenterology, oncology, neurosurgery, and fertility services for Medicare Advantage members in New York. Services performed without proper prior authorization may be denied payment.
Effective September 1, 2026, Anthem will require prior authorization for 24 new medical codes including gastroenterology tests, drug assays, neurostimulation procedures, and various surgical procedures for Medicare Advantage members in Ohio. Claims submitted without proper precertification may be denied payment.
Anthem Blue Cross and Blue Shield of Georgia is adding prior authorization requirements for 26 specific medical codes effective September 1, 2026, for Medicare Advantage members only. These codes span multiple specialties including gastroenterology, oncology, neurostimulation procedures, and various surgical interventions.
Policy 2.01.28, Sleep Studies, states that facility-based polysomnography (PSG) is medically appropriate when home sleep testing is negative, inconclusive, or technologically inadequate, and lists further indications such as CNS hypoventilation, a BMI of 45 or greater, and a child being considered for adenotonsillectomy to treat obstructive sleep apnea (OSA). It states that a facility-based CPAP titration study is medically appropriate when PSG criteria are met and the individual has co-morbid conditions with a positive OSA diagnosis, central or mixed sleep apnea, significant hypoxemia, or oxygen deficiency requiring supplemental oxygen. The 01/22/26 annual review left policy intent unchanged.
Aetna considers actigraphy testing (for example, Actiwatch) and accelerometry experimental, investigational, or unproven for listed uses, including diagnosing sleep disorders, diagnosing Alzheimer's disease, diagnosing hypertension, detecting seizures during sleep, and monitoring individuals with motor neuron diseases. CPT 95803 (actigraphy testing, minimum of 72 hours to 14 consecutive days of recording) and many listed ICD-10 codes, including those for depression, schizophrenia, Parkinson's disease and cerebral infarction, are not covered for the indications listed.
Aetna considers actigraphy testing experimental, investigational, or unproven for indications including defining lithium response dimensions in bipolar disorders, detection or screening of apnea, diagnosis of Alzheimer's disease, diagnosis of hypertension, evaluation of depression, and evaluation of schizophrenia. Aetna considers accelerometry experimental, investigational, or unproven for indications including evaluating functional ability in the elderly, differential diagnosis of tremor syndromes, gait analysis in persons with hip osteoarthritis, and monitoring of physical activity during rehabilitation of persons with stroke. CPT code 95803 (actigraphy testing, recording, analysis, interpretation and report, minimum of 72 hours to 14 consecutive days of recording) and CPT codes 0533T through 0536T (continuous recording of movement disorder symptoms) are not covered for the indications listed in the policy.
Actigraphy is considered investigational when used as the sole technique to record and analyze body movement, including its use to evaluate sleep disorders. The investigational statement does not apply to actigraphy used as a component of portable sleep monitoring, and that component should not be separately reported. The policy was reviewed on 10/16/2026, the policy section was updated to reference the policy guidelines, and the policy statements are unchanged.
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