95810
Polysom 6/> yrs 4/> param
Code typePrimary
Payment statusActive (A)
Global periodNone
Whole-Procedure Pricing
Line
Qty
Global fee
Pro fee
Primary95810Polysom 6/> yrs 4/> param
1
$673.70
$673.70
RVU Breakdown
Component
Office
Facility
Work
2.44
2.44
Practice expense
17.47
17.47
Malpractice
0.26
0.26
Total RVU
20.17
20.17
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