Sleep Studies Policy Updated

Date: May 22, 2025

Attention: All Providers

Effective Date: March 1, 2025

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that updates have been made to the Sleep Studies Medicaid Policy, effective for dates of service on or after March 1, 2025.

Updates to policy include:

Expansion of the Sleep Studies Medicaid Policy to include a new home sleep study test.

Procedure code 95800 will become a benefit of Texas Medicaid for patients who are 18 years of age or older effective March 1, 2025.

Procedure code 95800 describes a device that measures three or more channels, including pulse oximetry, actigraphy, and peripheral arterial tone (PAT).
Clarified diagnosis restrictions and prior authorization requirements.
Clarified reimbursement/billing guidelines.

Limitation Updates

Procedure code 95800 is limited to one study per day, any provider and two tests per rolling year, any provider:

Procedure Codes	Limitations
95800	One study per day, any provider

Provider Type Updates

Procedure code 95800 may be reimbursed to the following provider types and places of service:

Procedure Codes

Limitations

Office

Physician, Portable X-Ray, Radiological and

Physiological Lab

Outpatient Hospital

Hospital, Portable X-Ray, Radiological and

Physiological Lab, Rural Emergency Hospital

Resources

A copy of the final draft of the Sleep Studies policy can be found in the Texas Medicaid Provider Procedure Manual (TMPPM), Medical and Nursing Specialists, Physicians, and Physician Assistants handbook, Section 9.2.71.

Next step for providers: Providers are encouraged to share this communication with staff.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
https://www.texaschildrenshealthplan.org/provideralerts.