Date: February 7, 2025
Attention: All Providers
Effective date: March 1, 2025
Call to action: The purpose of this communication is to inform providers that 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).
How this impacts providers: 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 Service | Provider Type |
| Office | Physician, Portable X-Ray, Radiological and Physiological Lab |
| Outpatient Hospital | Hospital, Portable X-Ray, Radiological and Physiological Lab, Rural Emergency Hospital |
Next steps: Providers should share this communication with their staff.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts,log into:
www.texaschildrenshealthplan.org/provideralerts.