Prior Authorization
Humana Prior Authorization for CPT 95810
Laboratory-assisted sleep studies including polysomnography for sleep apnea diagnosis · Standard commercial plans
Source
Humana Commercial Preauthorization and Notification List (July 2024)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
Humana requires prior authorization for in-lab polysomnography. Approved when HST is negative but high clinical suspicion remains, significant cardiopulmonary disease complicates HST interpretation, non-respiratory sleep disorder is suspected (narcolepsy, PLMD, REM behavior disorder), or CPAP titration is needed. HST preferred as initial diagnostic tool for uncomplicated suspected OSA.
Documentation checklist
- ✓Clinical sleep evaluation
- ✓ESS or STOP-BANG score
- ✓Comorbidity documentation
- ✓HST results if applicable
Submission channels
Phone
1-800-444-9137Fax
1-877-418-05062026 Medicare rate for CPT 95810
Office (non-facility)
$673.70
Facility
$673.70
Total RVUs (office)
20.17
Conversion factor
$33.4009
National Medicare Physician Fee Schedule amounts (GPCI 1.0). Humana's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 95810 code page.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Clinical sleep evaluation, ESS or STOP-BANG score, Comorbidity documentation….
- 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 Humana require prior authorization for CPT 95810?
- Yes. Humana requires prior authorization for CPT 95810 (Laboratory-assisted sleep studies including polysomnography for sleep apnea diagnosis) under Standard commercial plans per its published clinical policy.
- What documentation does Humana require for CPT 95810?
- Clinical sleep evaluation; ESS or STOP-BANG score; Comorbidity documentation; HST results if applicable
- How much does Medicare pay for CPT 95810 in 2026?
- In 2026, the national Medicare allowable for CPT 95810 is $673.70 in an office setting and $673.70 in a facility. Commercial allowables for Humana are typically negotiated against this benchmark.
- What if Humana denies the PA for CPT 95810?
- 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 Humana PA lookups
CPT 95810 prior authorization by payer
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