95808
Polysom any age 1-3> param
Code typePrimary
Payment statusActive (A)
Global periodNone
Whole-Procedure Pricing
Line
Qty
Global fee
Pro fee
Primary95808Polysom any age 1-3> param
1
$512.37
$512.37
RVU Breakdown
Component
Office
Facility
Work
1.70
1.70
Practice expense
13.44
13.44
Malpractice
0.20
0.20
Total RVU
15.34
15.34
Payment Policy & Modifiers
Allowed adjustments
Assistant surgeon -80/81/8216% · documented
Assistant at surgery (mod 80/81/82) paid at 16% if medical necessity is documented.
Prof / tech split -26 / -TCSplit
Has professional (-26) and technical (-TC) components, each priced separately.
Not applicable to this code
Bilateral -50Multiple procedure Co-surgeon -62Team surgeon -66