What insurance policy changes affect CPT 95805?

There are 8 tracked policy changes affecting CPT 95805, including updates from Ambetter, Blue Cross Blue Shield of Rhode Island, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 95805?

Payers that have issued tracked updates for CPT 95805 include: Ambetter, Blue Cross Blue Shield of Rhode Island, Aetna, Health Net, UPMC Health Plan, Nevada Medicaid.

How do I get notified when CPT 95805 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 95805. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 95805?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

95805 — A test measuring how quickly you fall asleep multiple times throughout the day to check for sleep disorders.: Insurance Policy Changes

95805 Insurance Policy Changes

CPT 95805, in plain terms, covers A test measuring how quickly you fall asleep multiple times throughout the day to check for sleep disorders. CPT 95805 is referenced in 8 tracked payer policy changes from Ambetter, Blue Cross Blue Shield of Rhode Island, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 95805 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Medical policy updates

Blue Cross Blue Shield of Rhode Island·Effective Nov 1, 2026

This policy update consolidates multiple medical policies effective November 1, 2026, with key changes including: (1) molecular testing codes for pulmonary nodules moving to a separate biomarker policy with no coverage changes; (2) genetic testing for mental health conditions replacing an obsolete test with OptimalRx Plus (not covered for Medicare Advantage, not medically necessary for commercial); (3) shoulder joint replacement requiring prior authorization with revised medical criteria; (4) ProMark Risk Score policy consolidation with no coverage changes; and (5) removal of prior authorization for in-lab sleep studies (CPT 95805, 95808, 95810, 95811) for commercial products effective October 1, 2026. Additionally, Medicare Advantage coverage is now subject to change at Medicare's discretion for LTACH admissions.

95805 Insurance Policy Changes

Effective 10/1/26: Removal of Prior Authorization Requirement for Certain Procedures

Effective October 1, 2026: Removal of Prior Authorization Requirement for Certain Procedures

Medical policy updates

Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test (MWT) (CPB 0330, reviewed 2026-05-20)

25-1000 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency

Pause in Prior Authorization Policies

Pause in Prior Authorization Policies

Claims for Sleep Study Procedure Codes Billed With Modifier TC or Modifier 26