Prior Authorization
Aetna Prior Authorization for CPT 95783
Polysomnography and sleep studies including multiple sleep latency testing, attended sleep studies, and CPAP/bilevel ventilation initiation for various age groups · Standard commercial plans
Source
Aetna Participating Provider Precertification List 2026 (Updated May 1, 2026)Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.
Clinical criteria
Aetna lists this code under Special programs: Polysomnography (attended sleep studies). The PDF states listed plans require precertification except for inpatient facility, emergency room, or observation-bed status and identifies EviCore as the preauthorization route where applicable. Evidence: PDF p.37, Special programs, Polysomnography.
Documentation checklist
- ✓Completed EviCore preauthorization request
- ✓Medical records requested for delegated clinical review
Submission channels
Phone
1-888-622-7329Fax
1-800-540-24062026 Medicare rate for CPT 95783
Office (non-facility)
$1069.16
Facility
$1069.16
Total RVUs (office)
32.01
Conversion factor
$33.4009
National Medicare Physician Fee Schedule amounts (GPCI 1.0). Aetna's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 95783 code page.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Completed EviCore preauthorization request, Medical records requested for delegated clinical review.
- 3Submit via phone or fax, or the payer portal.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Aetna require prior authorization for CPT 95783?
- Yes. Aetna requires prior authorization for CPT 95783 (Polysomnography and sleep studies including multiple sleep latency testing, attended sleep studies, and CPAP/bilevel ventilation initiation for various age groups) under Standard commercial plans per its published clinical policy.
- What documentation does Aetna require for CPT 95783?
- Completed EviCore preauthorization request; Medical records requested for delegated clinical review
- How much does Medicare pay for CPT 95783 in 2026?
- In 2026, the national Medicare allowable for CPT 95783 is $1069.16 in an office setting and $1069.16 in a facility. Commercial allowables for Aetna are typically negotiated against this benchmark.
- What if Aetna denies the PA for CPT 95783?
- Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.
Other Aetna PA lookups
CPT 95783 prior authorization by payer
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